Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups.
OBJECTIVE
Online patient portals are being widely implemented; however, no studies have examined whether portals influence health behaviors or outcomes similarly across patient racial/ethnic subgroups. We evaluated longitudinal changes in statin adherence to determine whether racial/ethnic minorities initiating use of the online refill function in patient portals had similar changes over time compared with Whites.


METHODS
We examined a retrospective cohort of diabetes patients who were existing patient portal users. The primary exposure was initiating online refill use (either exclusively for all statin refills or occasionally for some refills), compared with using the portal for other tasks (eg, exchanging secure messages with providers). The primary outcome was change in statin adherence, measured as the percentage of time a patient was without a supply of statins. Adjusted generalized estimating equation models controlled for race/ethnicity as a primary interaction term.


RESULTS
Fifty-eight percent of patient portal users were white, and all racial/ethnic minority groups had poorer baseline statin adherence compared with Whites. In adjusted difference-in-difference models, statin adherence improved significantly over time among patients who exclusively refilled prescriptions online, even after comparing changes over time with other portal users (4% absolute decrease in percentage of time without medication). This improvement was statistically similar across all racial/ethnic groups.


CONCLUSIONS
Patient portals may encourage or improve key health behaviors, such as medication adherence, for engaged patients, but further research will likely be required to reduce underlying racial/ethnic differences in adherence.


CONCLUSIONS
In a well-controlled examination of diabetes patients' behavior when using a new online feature for their healthcare management, patient portals were linked to better medication adherence across all racial/ethnic groups.
University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA Courtney.Lyles@ucsf.edu.
Courtney R
CR
Lyles
University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA.
Urmimala
U
Sarkar
University of California San Francisco, Department of Medicine, Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA University of California San Francisco, Center for Vulnerable Populations, San Francisco, CA, USA Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA.
Dean
D
Schillinger
Group Health Research Institute, Seattle, WA, USA.
James D
JD
Ralston
Kaiser Permanente, National Market Research, Oakland, CA, USA.
Jill Y
JY
Allen
Kaiser Permanente, National Market Research, Oakland, CA, USA.
Robert
R
Nguyen
Kaiser Permanente Northern California, Division of Research, Oakland, CA, USA.
Andrew J
AJ
Karter
D000328:Adult; D000368:Aged; D002140:California; D057286:Electronic Health Records; D055695:Electronic Prescribing; D005260:Female; D055991:Health Records, Personal; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D055118:Medication Adherence / Q000208:ethnology*; D008875:Middle Aged; D044469:Racial Groups
diabetes; electronic health records; medication adherence; race/ethnicity