Disparities in Electronic Health Record Portal Access and Use among Patients with Cancer
Menée aux Etats-Unis par enquête auprès de 28 942 patients atteints d'un cancer, cette étude identifie les facteurs associés à l'utilisation d'un portail informatique donnant accès au dossier médical et permettant de déclarer les symptômes pendant et après les traitements anticancéreux
BACKGROUND: Electronic health record (EHR)-linked portals may improve healthcare quality for cancer patients. Barriers to portal access and use undermine interventions leveraging portals to reduce cancer care disparities. This study examined portal access and persistence of portal use and associations with patient- and structural-factors prior to the implementation of three portal-based interventions within the Improving the Management of symPtoms during And following Cancer Treatment (IMPACT) Consortium. METHODS: Portal use data were extracted from EHRs for the 12 months preceding intervention implementation. Sociodemographic factors, mode of accessing portals (web vs. mobile), and number of clinical encounters prior to intervention implementation were also extracted. Rurality was derived using Rural Urban Commuting Area codes. Broadband access was estimated using the 2015-2019 American Community Survey. Multiple logistic regression models tested associations of these factors with portal access (ever access/never accessed) and persistence of portal use (accessed the portal
≤
20 weeks vs.
≥
21 weeks in the 35 week study period). RESULTS: Of the 28,942 eligible patients, 10,061 (35%) never accessed the portal. Male, racial/ethnic minority, rural dwelling, not working, and limited broadband access were significantly associated with lower odds of portal access. Younger age and more clinical encounters were associated with higher odds of portal access. Of those with portal access, 25% were persistent users. Using multiple modalities for portal access, being middle-aged, and having more clinical encounters were significantly associated with persistent portal use. CONCLUSION: Patient- and structural-factors affect portal access and use and may exacerbate disparities in EHR-based cancer symptom surveillance and management.