Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics

TLDR

Electronic health record patient portals empower patients by giving them access to medical information, yet their use among nephrology patients has been poorly characterized. The study aimed to describe portal adoption, track secular trends, and evaluate its association with blood‑pressure control in a cohort of nephrology patients. Researchers conducted a retrospective cohort analysis of 2,803 patients seen between 2010 and 2012 at four university‑affiliated nephrology offices, extracting sociodemographic, clinical, and neighborhood income data from the EHR to assess portal use and hypertension outcomes. Portal use was observed in 39% of patients, with high engagement in lab results, medical history, appointments, medications, refills, and provider advice; adoption was lower among older adults, African‑Americans, Medicaid recipients, and those from low‑income neighborhoods, increased over time, and was modestly linked to better blood‑pressure control, though the association was not significant after full adjustment.

Abstract

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).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.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).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.