Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics.
OBJECTIVE
Electronic health record (EHR) patient portals allow individuals to access their medical information with the intent of patient empowerment. However, little is known about portal use in nephrology patients. We addressed this gap by characterizing adoption of an EHR portal, assessing secular trends, and examining the association of portal adoption and BP control (<140/90 mmHg).


METHODS
Patients seen between January 1, 2010, and December 31, 2012, at any of four university-affiliated nephrology offices who had at least one additional nephrology follow-up visit before June 30, 2013, were included. Sociodemographic characteristics, comorbidities, clinical measurements, and office visits were abstracted from the EHR. Neighborhood median household income was obtained from the American Community Survey 2012.


RESULTS
Of 2803 patients, 1098 (39%) accessed the portal. Over 87% of users reviewed laboratory results, 85% reviewed their medical information (e.g., medical history), 85% reviewed or altered appointments, 77% reviewed medications, 65% requested medication refills, and 31% requested medical advice from their renal provider. In adjusted models, older age, African-American race (odds ratio [OR], 0.50; 95% confidence interval [95% CI], 0.39 to 0.64), Medicaid status (OR, 0.53; 95% CI, 0.36 to 0.77), and lower neighborhood median household income were associated with not accessing the portal. Portal adoption increased over time (2011 versus 2010: OR, 1.38 [95% CI, 1.09 to 1.75]; 2012 versus 2010: OR, 1.95 [95% CI, 1.44 to 2.64]). Portal adoption was correlated with BP control in patients with a diagnosis of hypertension; however, in the fully adjusted model this was somewhat attenuated and no longer statistically significant (OR, 1.11; 95% CI, 0.99 to 1.24).


CONCLUSIONS
While portal adoption appears to be increasing, greater attention is needed to understand why vulnerable populations do not access it. Future research should examine barriers to the use of e-health technologies in underserved patients with CKD, interventions to address them, and their potential to improve outcomes.
Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania;
Manisha
M
Jhamb
Vanderbilt Center for Kidney Disease, Nashville, Tennessee; Division of Nephrology and Hypertension and.
Kerri L
KL
Cavanaugh
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee; and.
Aihua
A
Bian
Department of Biostatistics, Vanderbilt University, Nashville, Tennessee; and.
Guanhua
G
Chen
Vanderbilt Center for Kidney Disease, Nashville, Tennessee; Division of Nephrology and Hypertension and.
T Alp
TA
Ikizler
Division of Nephrology, University of New Mexico, Albuquerque, New Mexico.
Mark L
ML
Unruh
Vanderbilt Center for Kidney Disease, Nashville, Tennessee; Division of Nephrology and Hypertension and khaled.abdel-kader@vanderbilt.edu.
Khaled
K
Abdel-Kader
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009398:Nephrology; D012189:Retrospective Studies
chronic kidney disease; electronic health record; healthcare disparities; patient portal; personalized health record