JMIR Publications

ABSTRACT

Background:

Healthcare systems are increasingly encouraging patients to use patient portals to communicate with clinicians, view laboratory test results, and participate in video visits. There is limited information about how usage differs among older adults.

Objective:

This study aimed to learn how patient portal and video visit usage differ by age, race, and ethnicity among older adult patients who have access to the same digital health resources.

Methods:

This cross-sectional study used electronic health record (EHR) and survey data for adults aged 65-85 years who were members of a large Northern California healthcare delivery system during all of 2019-2020. The EHR cohort included 471,152 adults (320,686 White, 35,892 Black, 44,922 Latino, 20,786 Chinese, 28,732 Filipino, 8,473 South Asian, 6,716 Japanese, 2,930 Vietnamese, and 2,015 Korean). Racial and ethnic group and age group (65-75 vs. 76-85 years) differences were examined for having an activated portal account by December 2020, performance of two portal activities (sending ≥1 message to clinician during 2019-2020 and viewing ≥1 lab test result in 2020), and participation in ≥1 video visit during 2020. Modified log-Poisson regression was used to examine prevalence ratios for portal and video visit utilization, comparing racial and ethnic groups to White adults and Asian ethnic groups to Chinese adults after adjusting for sex and age. Weighted data from a 2020 health plan survey were also used to compare internet use factors among White (n=2867), Black (n=306), Latino (n=343), Chinese (n=225), and Filipino (n=242) adults survey respondents within the same EHR cohort.

Results:

In 2020, Black, Latino, and Filipino adults were less likely than White adults and Filipino adults less likely than Chinese adults to have a patient portal account. Black, Latino, Filipino, Korean, Vietnamese, and South Asian adults were less likely to have used secure messaging and online lab view than White adults, while Chinese and Japanese adult usage was similar to White adults. Performance of both portal activities was lower among Filipino, Vietnamese, and Korean adults than Chinese adults. Video visit usage was lower among Black and Latino and higher among Chinese and South Asian compared to White adults (ages 76-85 only) and lower among Filipino, Korean, and Vietnamese compared to Chinese adults. Survey data suggested that underlying differences in internet use may partially explain differences in use of secure messaging by Black, Latino, and Filipino adults compared to both White and Chinese adults.

Conclusions:

Patient portal and video visit use differed by racial/ethnic and age groups among older adult patients in an integrated healthcare delivery system with uniform access to the same patient portal. Internet use factors may contribute to these differences. Differences in patient portal and video visit use across Asian subgroups underscores the importance of disaggregating utilization data by Asian ethnicity.