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  • Publication # 13-RA006

Studies identify patients most and least likely to communicate with physicians using a secure Internet-based portal

Health Information Technology

Younger age, higher income and education levels, and lack of a chronic illness are factors that make primary care patients more likely to use a secure, Internet-based patient–physician communications system (a portal), according to a new study. Such portals are being used increasingly by health care systems to improve two-way communications between patients and physicians. These portals can also be used by patients to place medication refill orders, schedule appointments, see their electronic health record and test results, take online health risk appraisals, inform clinicians of any health changes, receive patient reminders and alerts, and more. In an effort to make secure Internet-based portals useful for as many patients as possible, the researchers recruited 674 patients at five primary care clinics affiliated with an academic health center, 95 percent of whom completed initial waiting room surveys. Of 369 patients who enrolled in the portal during its pilot-testing at three of the clinics, 295 were sent enrollment surveys and 355 were sent the follow-up survey (3 months after portal enrollment). The study, described in two papers here, was funded in part by the Agency for Healthcare Research and Quality (HS17035).

Kruse, R.L., Koopman, R.J., Wakefield, B.J., and others. (2012 May). "Internet use by primary care patients: Where is the digital divide?" Family Medicine 44(5), pp. 342-347.

The researchers approached 713 patients to participate in a cross-sectional (waiting room) survey of primary care outpatients about desired Internet portal features. The 638 respondents included 499 Internet users (78 percent) and 139 nonusers (22 percent). The most common barriers to Internet use reported by the nonusers were lack of computer or Internet access, and not knowing how to use email or the Internet. Younger age, higher levels of education, higher household income, and lack of chronic illness were associated with greater Internet use. Once the researchers adjusted their data for age and other factors, having a chronic illness was not a significant factor in predicting lack of Internet use. The researchers suggest that the Internet access of older adults with chronic illness will need to be improved if this group is to reap the benefits of health information technology.

Wakefield, D.S., Kruse, R.L., Wakefield, B.J., and others. "Consistency of patient preferences about a secure Internet-based patient communications portal: Contemplating, enrolling, and using." (2012, November/ December). American Journal of Medical Quality 27(6); pp. 494-502.

In this paper, the researchers looked at the intensity of internet use among the 499 Internet users participating in the waiting room survey. Patients who enrolled and used a patient portal initially perceived only limited improvements in care because of the portal. Of the 163 respondents to the enrollment survey, 50.3 percent reported having emailed their physicians within the past year, with 37 percent sending four or more emails. The majority (79.8 percent) had not ordered prescription refills online, and only 13.9 percent had previously used an online personal health record.

Enrollment survey respondents were much more interested than waiting room respondents in sending their doctors emails, viewing lab and test results, and requesting medication refills. The 79 patients who completed both the enrollment and followup surveys and logged into the portal reported only modest use of the portal during the first 3 months. Many reported problems navigating the secure email function or they did not receive timely answers, and a large proportion of those surveyed reported inaccuracies in their medication lists.


Page last reviewed March 2013
Internet Citation: Studies identify patients most and least likely to communicate with physicians using a secure Internet-based portal: Health Information Technology. March 2013. Agency for Healthcare Research and Quality, Rockville, MD.


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