Study Finds Health Care Disparities in Who Enrolls in Oncology Patient Portals

A recent study examined who enrolls in patient portals used by oncology practices and found disparities, which could have long-term effects as the use of remote health care communication increases.

Patient portals provide a view into an electronic health record (EHR); however, it is already known that the use of these portals differs by race and ethnicity, socioeconomic status, and age, all of which can affect the quality of oncology care. Portals allow for the review of test results and appointment notes, facilitation of second opinions, or for secure communication with oncologists.

Other studies have shown the benefit of EHR portals, wrote the authors of the current study, published in JAMA Oncology. One indicated that patient communication patterns via portals predict the discontinuation of therapy in patients with breast cancer. Another, of patients with multiple complex chronic medical conditions, showed that portals were linked with more office visits, fewer emergency department visits, and fewer preventable hospitalizations.

In this study, researchers retrospectively analyzed right-censored enrollment in a patient portal at the University of California, San Francisco, between June 2012 and March 2020.

During that time, 266,917 patients had completed a visit at the cancer center, and the median (interquartile range [IQR]) age was 52 years (36-65 years).

Median (IQR) time to enrollment in the portal was 262 days (0-1327 days), and the median (IQR) follow-up based on the reverse Kaplan-Meier method was 217 days (8-1397 days).

Disparities in time to enrollment were seen across sex, age, race/ethnicity, and primary language on univariate and multivariate analysis.

Patients aged 18 to 29 years and 30 to 39 years were most likely to enroll, followed by those in their 40s, and then enrollment decreased. Patients between 70 and 79 years and 80 or older had the least rates of enrollment.

By race, Black patients were the least likely to enroll at any point in time, and Whites were the most likely. Compared with women, men showed a small delay and decrease in enrollment.

Patients who were single also had lower enrollment rates, as did those whose primary reported language was not English or who were Hispanic.

The researchers said the university is working to improve the enrollment process, since it has been identified as a hindrance to the portal, through the use of text messages, email, use of third-party identification instead of activation codes, and simplified proxy registration. They are also working to translate the patient portal into other languages.

The study had a number of limitations:

• It was a single-institution study with a racial minority population that is overrepresented, compared with national statistics.
• It did not include characteristics such as health/technical literacy, education, and income.
• The disparities may have been created by other factors, such as systemic, institutional, and clinician-level influences.

“Future study may investigate the association between enrollment and use, patient satisfaction, and clinical outcomes,” the authors said.

Reference

Sinha S, Garriga M, Naik N, et al. Disparities in electronic health record patient portal enrollment among oncology patients. JAMA Oncol. Published online April 8, 2021. doi:10.1001/jamaoncol.2021.0540