JMIR Publications

ABSTRACT

Background:

As EPPs continue to gain popularity and systems transition to online tools for scheduling, communication, and telehealth, patients without access or skills to utilize these tools may be overlooked.

Objective:

This study analyzed patient-level and neighborhood-level factors, including eHealth literacy level and Area Deprivation Index (ADI), that may limit electronic patient portal (EPP) access within orthopaedic surgery.

Methods:

A cross-sectional survey-based study was performed at a single urban, tertiary academic medical center in the United States. Survey responses (n=287) collected sociodemographic characteristics, the eHealth Literacy Scale (eHEALS), and ADI, which is an address-generated national census measure of neighborhood disadvantage. The primary outcome measure was patient-reported barriers to EPP access/use. Bivariate analyses and multivariable logistic regressions were performed.

Results:

Forty-three percent of patients (n=124/287) self-reported barriers to EPP access. Reported barriers related to physical access (10%), technology discomfort (44%), and preference (63%). In the adjusted regressions, only low eHealth literacy and older age predicted any barriers to EPP use (p<0.001), including barriers of technology discomfort (p<0.001) and preference (low eHealth p<0.001; older age p=0.01). Patients with physical access-related barriers as opposed to technology discomfort or preference barriers had the lowest eHealth scores (17.0 vs. 27.0 vs. 27.0) and roughly a quartile higher ADI (73.0 vs. 53.5 vs. 58.0).

Conclusions:

Fewer physical access-related barriers were expressed compared to barriers of technology discomfort or preference and low eHealth literacy predicted patient-reported barriers to EPP use. Point of care screening with eHEALS may identify patients who require follow-up outside of the EPP during critical perioperative periods. Patient preference for EPP versus non-EPP communications should also be documented.