Differences in Patient Portal Engagement Among Hypertension Patients

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Hypertension—also known as high blood pressure—is a health issue that impacts close to half of the population in the United States. Given its magnitude, many patients are aware of the daily follow-up appointments with the clinical care team that are needed in order to not only properly regulate medications, but to keep track of progress as well.

Being that this constant communication among parties is a part of managing hypertension, patient portals that contain electronic health records (EHRs) also play a large role. In fact, care teams are continuing to heavily rely on these portals in the form of after-visit summaries and a layout of lab results among other features. The impact has been felt to the point that the portals have even been utilized to invite these patients to be a part of clinical trials.

On the other side of the coin however, disadvantaged patient populations—such as those in racial and ethnic minority groups, whose first language is not English, and those who do not have insurance—may struggle to keep their hypertension at bay.

A retrospective study published in JAMA Network Open¹ sought to confirm this theory of whether there are in fact disparities in engagement with patient portal use among those treated for high blood pressure in primary care.

Investigators used data from Advocate Health–Midwest, a healthcare system that serves Wisconsin’s urban and rural populations, along with Illinois’ metropolitan population. They included patients at least 18 years of age who had a documented hypertension diagnosis, along with at least one primary care visit in 2021 and another visit prior to that time.

The 2021 visit would be considered the baseline visit; the clinical and sociodemographic data (insurance, race and ethnicity, smoking status, and preferred language) would be pulled from the EHR of that baseline, and the patient portal engagement would then be measured the following year. Specifically, multivariate logistic regressions, displayed in the form of odds ratios (ORs) and 95% confidence intervals (CIs), were utilized to measure any associations between patient characteristics and patient portal engagement, correcting for any confounders that might be found.

Among the 366, 871 patients (mean [SD], 63.5 [12.6] years), 52.8% were female, 66.9% were non-Hispanic White, 19.7% were non-Hispanic Black, 7.8% were Hispanic, 3.4% were Asian, and 2.3% were of another race or ethnicity. During the aforementioned one-year study period that began in 2021, 70.5% logged onto the patient portal at least one time, 60.2% of them connecting around the time of their primary care physician visit, 35.7% accessed the portal more often, 28.9% engaged in messaging, and 8.7% shared home blood pressure readings.

Compared with White patients, non-Hispanic Black and Hispanic patients had lower odds of any access (Black: OR, 0.53; 95% CI, 0.52-0.54; Hispanic: OR, 0.66; 95% CI, 0.64-0.68), access around PCP visit time (Black: OR, 0.49; 95% CI, 0.48-0.50; Hispanic: OR, 0.62; 95% CI, 0.60-0.64), frequent access (Black: OR, 0.56; 95% CI, 0.55-0.57; Hispanic: OR, 0.71; 95% CI, 0.69-0.73), and messaging (Black: OR, 0.63; 95% CI, 0.61-0.64); Hispanic: OR, 0.71; 95% CI, 0.69-0.73).

The study authors concluded that, “In this cohort study of patients with hypertension, two-thirds had accessed the patient portal at least once, with a median number of logins of 28 per year. Despite the observed high rates of engagement, clear disparities were observed in terms of race and ethnicity, insurance status, preferred language, and tobacco use. To overcome the digital divide and prevent further disparities in hypertension outcomes, it is important to further evaluate patient portal adoption among these subpopulations and identify ways of increasing their engagement.”

Reference

1. Khatib R, Glowacki N, Chang E, Lauffenburger J, Pletcher MJ, Siddiqi A. Disparities in Patient Portal Engagement Among Patients With Hypertension Treated in Primary Care. JAMA Netw Open. 2024;7(5):e2411649. doi:10.1001/jamanetworkopen.2024.11649