Examining the Impact of the COVID-19 Pandemic on Patient Portal Use

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Many would agree that the COVID-19 pandemic revolutionized the future of healthcare, which, although being a heavy proclamation, is supported by a mountain of evidence. Healthcare has gone digital, as seen by the use of telehealth and patient portals, which allows individuals to access their health data at any time, assuming that one has internet connection.

This effort of providing accessible health data dates back to the 21st Century Cure Act that was signed into law in December 2016, so even before the start of pandemic, there was an urge to expand portal use, especially among members of the more vulnerable populations, such as older adults and those with comorbidities.

A cohort study published in JAMA Network Open¹ examined portal use during the 2019-2022 timeframe, electing to use data from the COVID-19 & Chronic Conditions (C3) study, which is an ongoing, longitudinal, telephone-based survey of participants who have various chronic conditions that would put them at higher risk for contracting the SARS-CoV-2 infection. These participants were middle-aged and older-adult primary care individuals who already had an active portal account.

Specifically, the C3 study was meant to report on patients’ health and lifestyle behaviors, health services use, their psychosocial characteristics, belief and actions pertaining to COVID-19, and their mental and physical health. The Patient Reported Outcomes Measurement Information Service instruments also measured anxiety and depression. When it came to each scale, the investigators calculated a raw score, which was then converted into corresponding T-scores and categorized using the various severity thresholds:

1. None (T-score <55)
2. Mild (T-score in the 55.0-59.9 range)
3. Moderate (T-score in the 60.0-69.9 range)
4. Severe (T-score ≥70)

Other information regarding the patients were also collected via interviews, such as demographic characteristics (ie, age, sex, self-reported race and ethnicity), socioeconomic status (including household income, number of family members in household, education level, employment status, and health insurance), self-reported chronic conditions, and one question on their overall health (rated as excellent, very good, good, fair, or poor). Race and ethnicity were broken down as Hispanic or Latinx, non-Hispanic Black, non-Hispanic White, and other (including Asian, Native American or Alaskan Native, and other self-reported races).

There were a total of 718 C3 study participants, with data on portal use only available for 536 of them, who were included in the analysis. Out of those 536 participants (mean [SD] age, 66.7 [12.0] years), 336 [62.7%] were female, 44 (8.2%) were Hispanic or Latinx, 142 (26.5%) were non-Hispanic Black, 322 (60.1%) were non-Hispanic White, and 20 individuals (3.7%) identified themselves as of another race, whether that be Asian, Native American or Alaskan Native, or a self-reported other race.

Portal login activity was higher during the three years of the COVID-19 pandemic compared with the 2019 baseline. Higher portal login activity was associated with sufficient health literacy (incidence rate ratio [IRR], 1.51; 95% CI, 1.18-1.94) and multimorbidity (IRR, 1.38; 95% CI, 1.17-1.64), while there was a correlation between lower portal activity and older age (≥70 years: IRR, 0.69; 95% CI, 0.55-0.85) and female gender (IRR, 0.77; 95% CI, 0.66-0.91).

When compared alongside non-Hispanic White patients, there was lower portal activity among Hispanic or Latinx patients (IRR, 0.66; 95% CI, 0.49-0.89), non-Hispanic Black patients (IRR, 0.68; 95% CI, 0.56-0.83), and patients who identified as other race (IRR, 0.42; 95% CI, 0.28-0.64).

The study authors concluded that “Although this study was focused on sociodemographic disparities of portal activity among patients with an active portal account, it is important to consider existing and shifting disparities among individuals who have never used the portal and addressing possible barriers in portal adoption.

“Furthermore, as telehealth and digital health tools continue to be an integral part of healthcare systems, future research would benefit from evaluating and optimizing digital literacy challenges as a potential barrier to portal adoption and use, as well as optimizing access to reliable internet or broadband services, particularly for communities that have historically had poor digital access due to limitations in neighborhood infrastructure.”

Reference

1. Yoon E, Hur S, Opsasnick L, et al. Disparities in Patient Portal Use Among Adults With Chronic Conditions. JAMA Netw Open. 2024;7(2):e240680. doi:10.1001/jamanetworkopen.2024.0680