Disparities in Digital Health Portal Use Persist Beyond the COVID-19 Pandemic

Although the COVID-19 pandemic led to an increase in electronic patient portal use, disparities in access due to health literacy persisted, according to research published in JAMA Network Open.¹

As digital health continues to evolve and research continues regarding its overall use and efficacy, health care professionals are keen on understanding why and how certain demographics use specific resources.¹ And at the height of the COVID-19 pandemic, digital health portals seemed to be more necessary than ever before.

“The COVID-19 pandemic disrupted face-to-face health care delivery and accelerated the adoption and use of digital health modalities, like patient portals,” according to the authors of a cohort study on the disparities of patient portal use during the most restrictive phase of the COVID-19 pandemic.¹

Prior to the pandemic, ongoing research was conducted to identify which demographics have access, would benefit most, and are more likely to use digital health portals for primary care needs.

As part of the recently published study on patient portal use, the authors collected data from 2019 to 2022 on the frequency of portal logins. They identified how often specific demographics logged into their portals compared with others during and after the pandemic.

Portal Use Disparities Among Specific Demographics

Analyzing the portal activities of 536 participants (mean age, 66.7± 12.0 years; 62.7% women), researchers identified the number of days each patient logged into their portal in 2019, 2020, 2021, and 2022.

Despite researchers only observing login frequencies, it is important to note that patient portals are used for several health care activities, such as scheduling appointments, viewing post-visit summaries, patient-clinician communication, and more.

With a mean participant age of 66.7, the authors’ goal was to identify disparities in portal logins among older individuals who were at greater risk of long-term COVID-19 complications during the pandemic. They also separated participants by age, sex, health literacy, and socioeconomic status to attain a greater understanding of demographical disparities.

“Populations with pre-existing risk factors, including those with low health literacy, may continue to be left behind in the shift toward digital health,” wrote the authors.

Despite the immediate overall rise in portal use during the pandemic, login frequencies were still significantly lower for patients aged 70 years and older, patients with a low socioeconomic status, and patients with limited health literacy.

Conversely, participants aged 60 years or younger with an adequate health literacy status logged into their portals most frequently.

More frequent logins were also reported by individuals with more than 3 chronic health conditions and men—although, the disparity between men and women was later deemed insignificant by 2022 login frequencies.

Patient Portal Changes Necessary to Create Greater Access

In 2016, the 21st Century Cures Act was signed into law,² giving Americans much more transparent access to their medical files and data.² But despite recent advancements in medical record-keeping, other hurdles—like access to the internet, new technology, and health care education—continue to leave low SES communities behind.

“As telehealth and digital health tools continue to be an integral part of health care systems, future research would benefit from evaluating and optimizing digital literacy challenges as a potential barrier to portal adoption and use, as well as optimizing access to reliable internet or broadband services, particularly for communities that have historically had poor digital access due to limitations in neighborhood infrastructure,” the authors concluded.

References

1. Yoon E, Hur S, Opsasnick L, et al. Disparities in patient portal use among adults with chronic conditions. JAMA Netw Open. 2024;7(2):e240680. doi:10.1001/jamanetworkopen.2024.0680

2. Bonamici S. 21st Century Cures Act; 2015. https://www.congress.gov/bill/114th-congress/house-bill/34