Patient Factors Associated With the Use of Online Portal Health Information in the Postpandemic Era: Cross-Sectional Analysis of a National Survey.

Abstract

Background: Patients' electronic access to their health information can improve long-term health outcomes. Few studies have evaluated barriers that may limit access to portal health information before the COVID-19 pandemic such as preference for in-person visits, lack of perceived need to use a patient portal system, and lack of comfort or experience with computers. With the increased use of telehealth during the pandemic, patients' comfort with portal applications and digital health literacy has improved.

Objective: The purpose of this study was to assess the prevalence of portal use and factors associated with patients' portal access after the COVID-19 pandemic.

Methods: This study used data from the 2022 National Cancer Institute's Health Information National Trends Survey (HINTS 6). Adult patients (aged ≥18 years) who responded to the survey question about patient portal access were included. A multivariate logistic regression analysis was performed to determine characteristics associated with portal access.

Results: A total number of 5958 patients were included (weighted n=245,721,106), with a mean age of 48.2 (20.1) years and were mostly female (119,538,392/236,138,857, 50.6%) and white (167,163,482/227,232,636, 73.6%). Overall, 61.3% (150,722,178/245,721,106) of all respondents reported accessing portals over the last 12 months and 43.7% (82,620,907/188,860,031) used multiple portals. Most participants (135,011,661/150,104,795, 89.9%) reported using portals to access test results, followed by viewing clinical notes (104,541,142/149,867,276, 69.8%) downloading personal health information (47,801,548/150,017,130, 31.9%). The likelihood of portal use significantly increased by 24.9% points (95% CI 19.4-30.5) when patients were offered access to portals by health care providers or insurers compared with those not offered access or did not know if they were offered access. The likelihood of portal use also increased by 19.5% points (95% CI 15.1-23.9) among patients with a health care provider encouraging them to access portals, compared to patients who did not receive encouragement to do so. Having a college education versus education below college level and living in metropolitan areas versus nonmetropolitan regions increased the probability of portal use by 6.9% points (95% CI 3.1-10.8) and 6.9% points (95% CI 1.3-12.6), respectively. Of note, males (compared with females) and those of Hispanic background (compared with non-Hispanic individuals) were less likely to be offered portal access by 10.8% points (95% CI 6.3-15.2) and 6.9% points (95% CI 1.7-12.1), respectively.

Conclusions: This study demonstrates that most Americans use patient portals, though certain patient populations such as those with less than college degree education or living in nonmetropolitan areas continue to face greater difficulty accessing them. Interventions targeted at equality in offering access to patient portals and encouraging patients to use them could advance equitable and widespread access to patient portals.