Disparities in registration and use of an online patient portal among older adults: findings from the LitCog cohort.
OBJECTIVE
To document disparities in registration and use of an online patient portal among older adults.


METHODS
Data from 534 older adults were linked with information from the Northwestern Medicine Electronic Data Warehouse on patient portal registration and use of functions (secure messaging, prescription reauthorizations, checking test results, and monitoring vital statistics). Age, gender, race, education, self-reported chronic conditions, and the Newest Vital Sign health literacy measure were available from cohort data.


RESULTS
Most patients (93.4%) had a patient portal access code generated for them, and among these 57.5% registered their accounts. In multivariable analyses, White patients (P < .001) and college graduates were more likely to have registered their patient portal (P = .015). Patients with marginal (P = .034) or adequate (P < .001) health literacy were also more likely to have registered their patient portal. Among those registering their accounts, most had messaged their physician (90%), checked a test result (96%), and ordered a reauthorization (55%), but few monitored their vital statistics (11%). Adequate health literacy patients were more likely to have used the messaging function (P = .003) and White patients were more likely to have accessed test results (P = .004). Higher education was consistently associated with prescription reauthorization requests (all P < .05).


CONCLUSIONS
Among older American adults, there are stark health literacy, educational, and racial disparities in the registration, and subsequent use of an online patient portal. These population sub-group differences may exacerbate existing health disparities.


CONCLUSIONS
If patient portals are implemented, intervention strategies are needed to monitor and reduce disparities in their use.
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
Samuel G
SG
Smith
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
Rachel
R
O'Conor
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
William
W
Aitken
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
Laura M
LM
Curtis
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA Department of Learning Sciences, Northwestern University, Evanston, IL, USA mswolf@northwestern.edu.
Michael S
MS
Wolf
Division of General Internal Medicine and Geriatrics, Northwestern University, Chicago, IL, USA.
Mita Sanghavi
MS
Goel
D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D004522:Educational Status; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055695:Electronic Prescribing; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records / Q000706:statistics & numerical data; D044469:Racial Groups; D014481:United States
disparities; education; health literacy; patient portal; race