SEARCHCOHORTepidemiology, public health

cohort·epidemiology, public health, internal medicine, family medicine, observational study·PMC10427930

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis

Journal of Medical Internet Research · 3 authors, 2 centres

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TL;DR

This retrospective study of 65,178 rural patients found that the number of chronic conditions a patient had was significantly associated with increased use of patient portal messaging, but this relationship was primarily driven by patients younger than 65 years.

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This study was a retrospective analysis of patient portal messaging use among 65,178 patients with chronic conditions in rural communities. Using a zero-inflated negative binomial model, researchers found that the number of chronic diagnoses was incrementally associated with increased portal messaging use, with patients having ≥7 conditions being approximately 11 times more likely to send messages than those with 1 condition. However, this significant relationship was driven primarily by patients aged <65 years; it was not significant for older patients. Other factors associated with increased use included being female, White, married, having private insurance, and living in an area with higher educational attainment and provider density. The study is limited by its single-center, rural sample and the exclusion of mental health diagnoses.

STUDY TYPE

cohort

SPECIALTY

epidemiology

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100% · A

ORIGINAL PAPER

PMC10427930

An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis

Journal of Medical Internet Research

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ABSTRACT

Abstract Background Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. Objective This study aimed to explore the factors associated with portal messaging use by rural patients. Methods We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient’s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient’s home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. Results A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition ( P <.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition ( P <.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions ( P <.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. Conclusions Patients’ use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity. Keywords: patient portal, multimorbidity, chronic disease, patient messaging, rural, mobile phone

CITATION EXPORT

Fernando L Chivela, Ashley E Burch, Oghale Asagbra. An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis. Journal of Medical Internet Research. (2023). https://doi.org/10.2196/44399

AUTHORS

3 · 2 CENTRES

Fernando L Chivela, Ashley E Burch, Oghale Asagbra

1Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
2Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States