title: Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review.
abstract: BACKGROUND
  Patient portals provide patients with the tools to better manage and understand their health status. However, widespread adoption of patient portals faces resistance from patients and providers for a number of reasons, and there is limited evidence evaluating the characteristics of patient portals that received positive remarks from patients and providers.
  
  
  OBJECTIVE
  The objectives of this systematic review are to identify the shared characteristics of portals that receive favorable responses from patients and providers and to identify the elements that patients and providers believe need improvement.
  
  
  METHODS
  The authors conducted a systematic search of the CINAHL and PubMed databases to gather data about the use of patient portals in the management of chronic disease. Two reviewers analyzed the articles collected in the search process in order remove irrelevant articles. The authors selected 27 articles to use in the literature review.
  
  
  RESULTS
  Results of this systematic review conclude that patient portals show significant improvements in patient self-management of chronic disease and improve the quality of care provided by providers. The most prevalent positive attribute was patient-provider communication, which appeared in 10 of 27 articles (37%). This was noted by both patients and providers. The most prevalent negative perceptions are security (concerns) and user-friendliness, both of which occurred in 11 of 27 articles (41%). The user-friendliness quality was a concern for patients and providers who are not familiar with advanced technology and therefore find it difficult to navigate the patient portal. The high cost of installation and maintenance of a portal system, not surprisingly, deters some providers from implementing such technology into their practice, but this was only mentioned in 3 of the 27 articles (11%). It is possible that the incentives for meaningful use assuage the barrier of cost.
  
  
  CONCLUSIONS
  This systematic review revealed mixed attitudes from patients and their providers regarding the use of patient portals to manage their chronic disease. The authors suggest that a standard patient portal design providing patients with the resources to understand and manage their chronic conditions will promote the adoption of patient portals in health care organizations.
authors.affiliation: School of Health Administration, College of Health Professions, Texas State University, San Marcos, TX, United States. scottkruse@txstate.edu.
authors.forename: Clemens Scott
authors.identifier: http://orcid.org/0000-0002-7636-1086
authors.initials: CS
authors.lastname: Kruse
authors.forename: Darcy A
authors.identifier: http://orcid.org/0000-0001-6461-7657
authors.initials: DA
authors.lastname: Argueta
authors.forename: Lynsey
authors.identifier: http://orcid.org/0000-0002-5096-2529
authors.initials: L
authors.lastname: Lopez
authors.forename: Anju
authors.identifier: http://orcid.org/0000-0001-9169-6928
authors.initials: A
authors.lastname: Nair
mesh_terms: D001290:Attitude; D002908:Chronic Disease / Q000628:therapy*; D003142:Communication; D019468:Disease Management; D057286:Electronic Health Records; D006282:Health Personnel; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D017060:Patient Satisfaction; D012648:Self Care / Q000295:instrumentation / Q000379:methods*
keywords: chronic disease; disease management; electronic health record (EHR); health information technology (HIT); internet; patient portal; self-management