Amirreza Fatehi1, Amanda Gonzalez1, David C Ring1, Mark Queralt2. 1. A. Fatehi, A Gonzalez, D. Ring, Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA. 2. M. Queralt, Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX, USA.
Abstract
BACKGROUND: Electronic health records often include a portal for secure patient-clinician communication. There is evidence that use of electronic portals increases satisfaction, treatment adherence, safety, and clinical outcomes. We want everyone to enjoy these benefits and we noticed low and uneven portal use. We studied factors that we can address to improve portal use. QUESTIONS/PURPOSES: After controlling for differences in patient characteristics, what psychological and demographic factors are associated with an increased likelihood of registering for an electronic health record portal among people seeking musculoskeletal specialty care? METHODS: We reviewed data on 5672 adult English or Spanish-speaking patients seen in a musculoskeletal specialty office between October 2017 and December 2019. Eighteen percent (996 patients) had missing measures of symptoms of depression and anxiety due to intermittent problems with survey technology, leaving 4676 for analysis, 42% (1970 of 4676) men and 58% (2706 of 4676) women with a mean age of 51±15, 76% (3569 of 4676) of patients were English speaking, 22% (1015 of 4676) were Spanish speaking, and 2% (92 of 4676) spoke another language. Seventy-seven percent (3620 of 4676) of patients were residents of Austin, Texas, USA, 4% (159) were from Pflugerville, Texas, USA, 3% (143) were from Del Valle, Texas, USA, and 16% (754 of 4676) were from other areas of Texas. Ninety nine percent of patients were residents of Texas (4645 of 4676). Twenty-three percent of patients visited the upper extremity team (1077 of 4676), 37% the lower extremity team (1721 of 4676), 21% the back and neck team (1002 of 4676), and 19% the sport medicine team (876 of 4676). Seventy eight percent of patients (3654 of 4676) registered in portal and 22% (1022 of 4676) did not. The omitted population were not different from our study population in terms of age, gender, language, residence, and region of symptoms. We used a two-question measure of symptoms of depression (Patient Health Quality-2 [PHQ-2]) and a two-question measure of symptoms of anxiety (General Anxiety Disorder-2 [GAD-2]). The primary outcome was portal registration. To account for potential confounding, a multivariable logistic regressions model was used to determine the influence of age, spoken language, city and state of residence, care team, number of completed visits and GAD and PHQ scores on portal registration. RESULTS: After controlling for potentially confounding variables such as state of residence, we found younger age (odds ratio 0.98 [95% CI 0.97 to 0.99]; p < 0.01), speaking English (OR 1.85 [95% CI 1.14 to 3.02]; p = 0.01) rather than Spanish (OR 0.27 [95% CI 0.17 to 0.45]; p < 0.01), seeking care for back or neck symptoms, (OR 3.84 [95% CI 2.60 to 5.66]; p < 0.01) and higher number of completed visits (OR 1.03 [95% CI 1.01 to 1.05]; p < 0.01) were associated with an increased likelihood of portal registration while living in Austin, Texas, USA (OR 0.68 [95% CI 0.53 to 0.87]; p < 0.01) and Del Valle, Texas, USA (OR 0.47 [95% CI 0.30 to 0.74]; p < 0.01) compared with Pflugerville, Texas, USA, or other cities, seeking care for upper extremity (OR 0.74 [95% CI 0.58 to 0.94]; p = 0.01) or lower extremity symptoms (OR 0.68 [95% CI 0.53 to 0.86]; p < 0.01), and greater symptoms of anxiety (GAD score) (OR 0.97 [95% CI 0.95 to 0.99]; p < 0.01) or depression (PHQ score) (OR 0.97 [95% CI 0.95 to 0.98]; p < 0.01) were associated with lower likelihood of registering for the portal. English language, city of residence, and seeking care for back or neck symptoms (due to insurance contracts) were all associated with higher socioeconomic status in our setting. CONCLUSIONS: The association of better mental and social health (financial, employment, housing and food security; connectedness) with registration in a communication portal directs us to be more intentional about efforts to specifically welcome disadvantaged people to participate in the portal and to study the impact and effectiveness of such efforts. LEVEL OF EVIDENCE: Level III, therapeutic study.
BACKGROUND: Electronic health records often include a portal for secure patient-clinician communication. There is evidence that use of electronic portals increases satisfaction, treatment adherence, safety, and clinical outcomes. We want everyone to enjoy these benefits and we noticed low and uneven portal use. We studied factors that we can address to improve portal use. QUESTIONS/PURPOSES: After controlling for differences in patient characteristics, what psychological and demographic factors are associated with an increased likelihood of registering for an electronic health record portal among people seeking musculoskeletal specialty care? METHODS: We reviewed data on 5672 adult English or Spanish-speaking patients seen in a musculoskeletal specialty office between October 2017 and December 2019. Eighteen percent (996 patients) had missing measures of symptoms of depression and anxiety due to intermittent problems with survey technology, leaving 4676 for analysis, 42% (1970 of 4676) men and 58% (2706 of 4676) women with a mean age of 51±15, 76% (3569 of 4676) of patients were English speaking, 22% (1015 of 4676) were Spanish speaking, and 2% (92 of 4676) spoke another language. Seventy-seven percent (3620 of 4676) of patients were residents of Austin, Texas, USA, 4% (159) were from Pflugerville, Texas, USA, 3% (143) were from Del Valle, Texas, USA, and 16% (754 of 4676) were from other areas of Texas. Ninety nine percent of patients were residents of Texas (4645 of 4676). Twenty-three percent of patients visited the upper extremity team (1077 of 4676), 37% the lower extremity team (1721 of 4676), 21% the back and neck team (1002 of 4676), and 19% the sport medicine team (876 of 4676). Seventy eight percent of patients (3654 of 4676) registered in portal and 22% (1022 of 4676) did not. The omitted population were not different from our study population in terms of age, gender, language, residence, and region of symptoms. We used a two-question measure of symptoms of depression (Patient Health Quality-2 [PHQ-2]) and a two-question measure of symptoms of anxiety (General Anxiety Disorder-2 [GAD-2]). The primary outcome was portal registration. To account for potential confounding, a multivariable logistic regressions model was used to determine the influence of age, spoken language, city and state of residence, care team, number of completed visits and GAD and PHQ scores on portal registration. RESULTS: After controlling for potentially confounding variables such as state of residence, we found younger age (odds ratio 0.98 [95% CI 0.97 to 0.99]; p < 0.01), speaking English (OR 1.85 [95% CI 1.14 to 3.02]; p = 0.01) rather than Spanish (OR 0.27 [95% CI 0.17 to 0.45]; p < 0.01), seeking care for back or neck symptoms, (OR 3.84 [95% CI 2.60 to 5.66]; p < 0.01) and higher number of completed visits (OR 1.03 [95% CI 1.01 to 1.05]; p < 0.01) were associated with an increased likelihood of portal registration while living in Austin, Texas, USA (OR 0.68 [95% CI 0.53 to 0.87]; p < 0.01) and Del Valle, Texas, USA (OR 0.47 [95% CI 0.30 to 0.74]; p < 0.01) compared with Pflugerville, Texas, USA, or other cities, seeking care for upper extremity (OR 0.74 [95% CI 0.58 to 0.94]; p = 0.01) or lower extremity symptoms (OR 0.68 [95% CI 0.53 to 0.86]; p < 0.01), and greater symptoms of anxiety (GAD score) (OR 0.97 [95% CI 0.95 to 0.99]; p < 0.01) or depression (PHQ score) (OR 0.97 [95% CI 0.95 to 0.98]; p < 0.01) were associated with lower likelihood of registering for the portal. English language, city of residence, and seeking care for back or neck symptoms (due to insurance contracts) were all associated with higher socioeconomic status in our setting. CONCLUSIONS: The association of better mental and social health (financial, employment, housing and food security; connectedness) with registration in a communication portal directs us to be more intentional about efforts to specifically welcome disadvantaged people to participate in the portal and to study the impact and effectiveness of such efforts. LEVEL OF EVIDENCE: Level III, therapeutic study.
Authors: Johannes F Plate; Sean P Ryan; Michael A Bergen; Cierra S Hong; David E Attarian; Thorsten M Seyler Journal: J Arthroplasty Date: 2018-11-10 Impact factor: 4.757
Authors: Gregory E Simon; James D Ralston; James Savarino; Chester Pabiniak; Christine Wentzel; Belinda H Operskalski Journal: J Gen Intern Med Date: 2011-03-08 Impact factor: 5.128
Authors: Bernd Löwe; Oliver Decker; Stefanie Müller; Elmar Brähler; Dieter Schellberg; Wolfgang Herzog; Philipp Yorck Herzberg Journal: Med Care Date: 2008-03 Impact factor: 2.983
Authors: Tara Ketterer; David W West; Victoria P Sanders; Jobayer Hossain; Michelle C Kondo; Iman Sharif Journal: Acad Pediatr Date: 2013-02-09 Impact factor: 3.107
Authors: David E Gerber; Andrew L Laccetti; Beibei Chen; Jingsheng Yan; Jennifer Cai; Samantha Gates; Yang Xie; Simon J Craddock Lee Journal: J Oncol Pract Date: 2014-07-08 Impact factor: 3.840
Authors: Lixin Song; Mark A Weaver; Ronald C Chen; Jeannette T Bensen; Elizabeth Fontham; James L Mohler; Merle Mishel; Paul A Godley; Betsy Sleath Journal: Patient Educ Couns Date: 2014-09-04
Authors: Duaa Aljabri; Adrian Dumitrascu; M Caroline Burton; Launia White; Mahmud Khan; Sudha Xirasagar; Ronnie Horner; James Naessens Journal: BMC Med Inform Decis Mak Date: 2018-07-27 Impact factor: 2.796
Authors: Aresh Al Salman; Michael Z Khatiri; Teun Cremers; David Ring; Jacob E Thomas; Amirreza Fatehi Journal: Arch Orthop Trauma Surg Date: 2020-11-20 Impact factor: 3.067