PCPs Crucial To Patient Portal Adoption
By Christine Kern, contributing writer
A new study finds older patients actually utilized portals at the highest rates.
A study published by the Annals of Family Medicine has found integrating promotion of online patient portals into primary care visits is the most effective way to increase portal usage. Researchers also found that one of three patients aged 60-69 utilized the portals – the highest rate of any age group studied.
The authors, who also conducted studies on patient engagement using an interactive preventive health record (IPHR), wrote, “To improve uptake, we hypothesized that practices could more effectively promote IPHR use by making it part of patient care and using approaches and workflows customized by practices. This manner of promotion would be more applicable to primary care than methods used by large integrated health systems. We extended our original study at eight practices to test this hypothesis in a large sample of patients exposed to the IPHR.”
“While patient portals can help to engage patients in their care and even lead to improved health outcomes, getting patients online has been difficult,” said Alex Krist, M.D., associate professor in the Department of Family Medicine and Population Health, VCU School of Medicine. “However, primary care practices can effectively encourage their patients to use a portal by making promotion of the portal part of routine care.”
Although critics of patient portals have hypothesized that online technologies might discriminate against older patients, findings in the 60-69-year age group of this study point to the contrary. “Older patients (60-69) were more likely to get online,” Krist said. “This seems like it was driven by the fact that they were more likely to have a chronic condition and more likely to have a need for health information, but it is still a finding counter to many people’s concern that older people won’t get online.”
Analyzing data from eight Virginia primary care practices, they find that integrating promotion of the portal into the office visit (via doctors and nurses) appears to be more effective at increasing usage rates than mailing invitations and other costly advertising campaigns used at large integrated systems.
A proactive and customized implementation strategy designed by practices resulted in 25.6 percent of patients using the IPHR, with the rate increasing 1.0 percent per month over 31 months. Fully 23.5 percent of IPHR users signed up within 1 day of their office visit. Older patients and patients with comorbidities were more likely to use the IPHR, but blacks and Hispanics were less likely. Older age diminished as a factor after adjusting for comorbidities. Implementation by practice varied considerably (from 22.1 to 27.9 percent) based on clinician characteristics and workflow innovations adopted by practices to enhance uptake.
The authors point out that this uptake was significantly greater than the 17 percent observed in a previously conducted efficacy trial, in which the portal was only promoted through mailings. To improve uptake, in this study the authors hypothesized that practices could more effectively promote IPHR use by making it part of patient care and using approaches and workflows customized by practices. This manner of promotion would be more applicable to primary care than methods used by large integrated health systems.
Ultimately, the study concludes that by directly engaging patients to use a portal and supporting practices to integrate use into care, primary care practices can match or potentially surpass the usage rates achieved by large health systems.