title: Use of e-Health services between 1999 and 2002: a growing digital divide.
abstract: OBJECTIVE
  To evaluate the patterns of e-Health use over a four-year period and the characteristics of users.
  
  
  METHODS
  Longitudinal, population-based study (1999-2002) of members of a prepaid integrated delivery system. Available e-Health services included ordering prescription drug refills, scheduling appointments, and asking medical questions.
  
  
  METHODS
  Rates of known access to e-Health services, and of e-Health use each quarter.
  
  
  RESULTS
  The number of members with known e-Health access increased from 51,336 (1.6%) in 1999 to 324,522 (9.3%), in 2002. The percentage of households in which at least one person in the household had access increased from 2.7% to 14.1%. Among the subjects with known access, the percentage of subjects that used e-Health at least once increased from 25.7% in 1999 to 36.2% in 2002. In the multivariate analysis, subjects who had a low expected clinical need, were nonwhite, or lived in low socioeconomic status (SES) neighborhoods were less likely to have used e-Health services in 2002. Disparities by race/ethnicity and SES persisted after controlling for access to e-Health and widened over time.
  
  
  CONCLUSIONS
  Access to and use of e-Health services are growing rapidly. Use of these services appears to be greatest among persons with more medical need. The majority of subjects, however, do not use any e-Health services. More research is needed to determine potential reasons for disparities in e-Health use by race/ethnicity and SES as well as the implications of these disparities on clinical outcomes.
authors.affiliation: Kaiser Permanente Medical Care Program, Oakland, CA 94612, USA. jth@dor.kaiser.org
authors.forename: John
authors.initials: J
authors.lastname: Hsu
authors.forename: Jie
authors.initials: J
authors.lastname: Huang
authors.forename: James
authors.initials: J
authors.lastname: Kinsman
authors.forename: Bruce
authors.initials: B
authors.lastname: Fireman
authors.forename: Robert
authors.initials: R
authors.lastname: Miller
authors.forename: Joseph
authors.initials: J
authors.lastname: Selby
authors.forename: Eduardo
authors.initials: E
authors.lastname: Ortiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D002648:Child; D002675:Child, Preschool; D019033:Delivery of Health Care, Integrated; D006801:Humans; D007223:Infant; D020407:Internet / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008875:Middle Aged; D017061:Prepaid Health Plans; D044469:Racial Groups; D012959:Socioeconomic Factors; D017216:Telemedicine / Q000706:statistics & numerical data*