title: Barriers to patient portal access among veterans receiving home-based primary care: a qualitative study.
abstract: BACKGROUND
  Electronic, or web-based, patient portals can improve patient satisfaction, engagement and health outcomes and are becoming more prevalent with the advent of meaningful use incentives. However, adoption rates are low, particularly among vulnerable patient populations, such as those patients who are home-bound with multiple comorbidities. Little is known about how these patients view patient portals or their barriers to using them.
  
  
  OBJECTIVE
  To identify barriers to and facilitators of using My HealtheVet (MHV), the United States Department of Veterans Affairs (VA) patient portal, among Veterans using home-based primary care services.
  
  
  METHODS
  Qualitative study using in-depth semi-structured interviews. We conducted a content analysis informed by grounded theory.
  
  
  METHODS
  Fourteen Veterans receiving home-based primary care, surrogates of two of these Veterans, and three home-based primary care (HBPC) staff members.
  
  
  RESULTS
  We identified five themes related to the use of MHV: limited knowledge; satisfaction with current HBPC care; limited computer and Internet access; desire to learn more about MHV and its potential use; and value of surrogates acting as intermediaries between Veterans and MHV.
  
  
  CONCLUSIONS
  Despite their limited knowledge of MHV and computer access, home-bound Veterans are interested in accessing MHV and using it as an additional point of care. Surrogates are also potential users of MHV on behalf of these Veterans and may have different barriers to and benefits from use.
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.|Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Rebecca G
authors.initials: RG
authors.lastname: Mishuris
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Stewart
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.|Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Gemmae M
authors.initials: GM
authors.lastname: Fix
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.|Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Marcello
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.|Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA.|HIV/Hepatitis Quality Enhancement Research Initiative (QUERI) Program, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.|eHealth Quality Enhancement Research Initiative (QUERI), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.
authors.forename: D Keith
authors.initials: DK
authors.lastname: McInnes
authors.affiliation: Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|Center for Healthcare Organization and Implementation Research (CHOIR), VA Health Services Research and Development Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA.|Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Timothy P
authors.initials: TP
authors.lastname: Hogan
authors.affiliation: Home Based Primary Care Program, VA Boston Healthcare System, Boston, MA, USA.|Salem State University, Salem, MA, USA.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Boardman
authors.affiliation: Section of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.|Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.|Harvard Medical School, Boston, MA, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
mesh_terms: D000368:Aged; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D005260:Female; D066296:Grounded Theory; D006699:Home Care Services; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D017060:Patient Satisfaction; D011320:Primary Health Care; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans
keywords: access to care; health information technology; vulnerable populations