title: Patient race/ethnicity and shared medical record use among diabetes patients.
abstract: BACKGROUND
  Previous studies have documented racial/ethnic differences in patients' use of websites providing shared electronic medical records between patients and health care professionals. Less is known about whether these are driven by patient-level preferences and/or barriers versus broader provider or system factors.
  
  
  METHODS
  Cross-sectional study of diabetes patients in an integrated delivery system in 2008-2009. Primary measures were race/ethnicity and shared medical record (SMR) use. Covariates included sociodemographics (age, sex, income, education), health status (comorbidity, diabetes severity), and provider characteristics (encouragement of SMR, secure messaging use, clinic).
  
  
  RESULTS
  The majority (62%) of Whites used the SMR, compared with 34% of Blacks, 37% of Asians, and 55% of other race/ethnicity (P<0.001). Most respondents (76%) stated that their provider had encouraged them to use the SMR, with no differences by race/ethnicity. Patients saw primary care providers who used a similar amount of secure messaging in their practices-except Asians, who were less likely to see high-messaging providers. In fully adjusted models, Blacks [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.11-0.30] and Asians (OR, 0.40; 95% CI, 0.20-0.77) were significantly less likely than Whites to use the SMR. When restricted to individuals reporting at least occasional Internet use, this finding remained for Black respondents (OR, 0.25; 95% CI, 0.10-0.63).
  
  
  CONCLUSIONS
  Among diabetes patients, differences in SMR use by race/ethnicity were not fully explained by differences in age, sex, sociodemographics, health status, or provider factors-particularly for Black patients. There were few racial/ethnic differences in provider encouragement or provider secure messaging use that would have suggested disparities at the provider level.
authors.affiliation: Center for Vulnerable Populations, University of California, San Francisco, CA, USA. lylesc@medsfgh.ucsf.edu
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Lynne T
authors.initials: LT
authors.lastname: Harris
authors.forename: Luesa
authors.initials: L
authors.lastname: Jordan
authors.forename: Lou
authors.initials: L
authors.lastname: Grothaus
authors.forename: Linda
authors.initials: L
authors.lastname: Wehnes
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Reid
authors.forename: James D
authors.initials: JD
authors.lastname: Ralston
mesh_terms: D022126:Access to Information; D000367:Age Factors; D000818:Animals; D003920:Diabetes Mellitus / Q000208:ethnology* / Q000628:therapy; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006282:Health Personnel; D006304:Health Status; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D057240:Patient Preference; D011320:Primary Health Care; D044469:Racial Groups / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors