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Study reveals racial/ethnic and income-related disparities in use of Web-based health services

Access to and use of Web-based health services are increasing rapidly. However, racial/ethnic minorities and low-income individuals are less likely to use electronic health care services (e-Health), perhaps exacerbating existing disparities in access to care, suggests a recent study of members of a large health maintenance organization (HMO) in California.

The HMO allowed members to use a password-protected account to access several e-Health services via a Web site. Members could use the site to request routine primary care visits or order refills for prescription drugs. They also could ask medical or prescription drug questions and receive a response within 24 hours from either a nurse or a pharmacist, as appropriate. Individuals were not able to access their electronic medical record, however.

Lead author, John Hsu, M.D., M.B.A., M.S.C.E., of the Kaiser Permanente Medical Care Program, and his colleagues examined HMO members' use of e-Health from 1999 to 2002. The number of members with an e-Health account increased from 51,336 (1.6 percent) in 1999 to 324,522 (9.3 percent) in 2002. The percentage of households in which at least one person had an account increased from 2.7 to 14.1 percent. Also, the proportion who used their account at least once increased from 25.7 to 36.2 percent.

Nevertheless, minority individuals were significantly less likely to use e-Health services compared with whites in 2002. Indeed, the gap in use between whites and minorities widened over the 4-year study period, after adjusting for other factors, including socioeconomic status (SES). Similarly, individuals living in low SES neighborhoods were 29 percent less likely than members in high SES neighborhoods to use e-Health services, and this gap also widened over time after adjusting for other factors, including race/ethnicity. The study was supported by the Agency for Healthcare Research and Quality (contract 290-00-0015).

See "Use of e-health services between 1999 and 2002: A growing digital divide," by Dr. Hsu, Jim Huang, Ph.D., James Kinsman, and others, in the March 2005 Journal of the American Medical Informatics Association 12(2), pp. 164-171.

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