Paradox: increased digital health access doesn’t impact underserved

An extensive online patient portal designed for a group of 2,800 kidney disease patients in western Pennsylvania remained unused by over 60 percent of the patients. The study by a team led by Vanderbilt University examined usage of features, impact on health factors and demographics over two years in four university-affiliated nephrology offices. Of the 40 percent who used the portal, the most used (80 percent +) were (in order) the ability to look at lab results, review their medical history and schedule or change appointments, followed by reviewing medications and obtaining prescription refills. Instead of narrowing disparity, it seemed to increase it, benefiting more upscale patients, who were likely to be white, married, young, on private insurance and with a higher neighborhood median household income. Non-users were more likely to be black, enrolled in Medicaid or Medicare, lower-income, older and unmarried. This latter group is also disproportionately impacted by chronic kidney disease. Results correspond to earlier studies on other chronic diseases like diabetes.

Most disappointing to the study authors is that participants did learn about the portal through fliers and pamphlets provided at the clinics, but weren’t trained on how to sign up or use the portal–a major gap. Other gaps pointed out were digital literacy, online access, privacy/security concerns, PC versus smartphone usage, online usage skills and not knowing preferences, for instance text messaging or delivering online information in a simplified mobile friendly format. Clinical Journal of the American Society of Nephrology, iHealthBeat, NPR.

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