People who sign up for and use their healthcare provider’s online portal differ in some key characteristics from those who do not use patient portals, reports a survey study in Medical Care.

“Our findings suggest that access to healthcare along with ongoing patient health needs influence usage of patient portal platforms,” according to the new research, led by Naheed Ahmed, Ph.D., MA, MPH, of NYU Grossman School of Medicine. Having health insurance and establishing a relationship with a primary care provider (PCP) appear to be key factors in having a patient portal account.

What factors contribute to disparities in patient portal use?

Online patient portals have many benefits, including increased engagement in care and improved health outcomes. Yet most Americans do not use their healthcare provider’s patient portal, or even sign up to create an account. Low rates of portal use are not simply explained by patient preferences or by a lack of Internet access.

To explore factors affecting healthcare portal use, Dr. Ahmed and colleagues performed an online survey using Amazon’s Mechanical Turk crowdsourcing platform. Participants answered questions regarding whether and how they used an online patient portal to connect with healthcare providers. The survey addressed a range of other factors as well, including health status, access to and attitudes toward technology, and health literacy.

The researchers used a technique called latent class analysis to identify the underlying factors influencing patient portal use, with adjustment for other characteristics. The analysis included survey responses from 489 participants.

Initial analysis showed some qualitative differences between participants who did and did not use online portals. Online portal users were more likely to live in urban areas and to have a higher level of education. Among non-users, lack of awareness and technical issues were the main reasons for not having an account.

Insurance and ongoing health needs are ‘key determinants’ of portal use

Patient portal users were much more likely to have a primary healthcare provider: 82.5% versus 32.5%. They were also more likely to report some kind of health condition (comorbidity) or disability.

In the latent class analysis, all of these characteristics were relevant to identifying groups of participants by patient portal usage. After adjustment for other factors, respondents with a primary care provider were about five times more likely to have created a patient portal account (odds ratio 5.48). In contrast, participants without health insurance were much less likely to have a patient portal account (odds ratio 0.17).

Respondents with a disability or comorbid condition were more likely to have an account (odds ratio 1.72 for each). This finding may be explained by patients with chronic conditions having more frequent medical appointments, and thus feeling more inclined to use a patient portal to stay in touch with their healthcare team.

Patient portal users had higher scores for self-efficacy (confidence in managing health issues) and positive attitudes toward media and technology. Surprisingly, portal non-users had higher health literacy scores.

The findings “reflect the relative importance of patients having health insurance and ongoing health needs as key determinants of patient portal usage,” Dr. Ahmed and colleagues write. Forming a relationship with a PCP “can be an important facilitator of patients creating a patient portal account, and remaining current and engaged with their health, including communicating with their healthcare team.”