Medical Information Searches In A Patient Portal Using Medlineplus Connect: An Analysis Of Usage By Predominantly Underserved Patients In A Ny State Network Of Fqhcs

Abstract

BACKGROUND: Patient Portals are secure websites that give patients access to their own medical records. One function, MedlinePlus Connect (MPC), lets patients use National Library of Medicine resources to look up unfamiliar medical and health-related vocabulary in their records. Increased access to this tool could improve access to timely, authoritative information, which in turn could increase patient-led management of their own illnesses, as well as psychological benefits in the form of an increased sense of control and confidence. OBJECTIVE: In a study population of safety-net patients, we seek to determine (a) associations between MPC use and various demographic and clinic usage characteristics and (b) predictors of MPC usage, with the purpose of understanding MPC user-ship in general and the nature of any disparities that may exist in usage of this tool. PATIENT POPULATION: We collaborated with the Institute for Family Health, a federally qualified health center network in New York. The study cohort is all IFH patients who had at least one in-person provider encounter between February 2011 (when MPC was implemented) and September 2014 (n=133,667). Of these, 31,718 (24%) logged in to their patient portal at least once. Among the portal users, 13,491 (43%) used MPC at least once. METHODS: This is a retrospective cohort study. Chi-Squared tests will be used to examine associations between MPC usage and various outcomes and patient characteristics. Correlation tests will examine relationships between MPC usage and other core variables. Regression models will be used to explore the predictors of MPC usage. RESULTS: Medicaid, dual-eligibles and self-pay constituted in aggregate 55.8% of all MPC users' insurance vs. 55.1% of all non-MPC users' insurance (P = 0.0004). Black MPC users constituted 22.4% of all MPC users vs. 21.7% of all non-MPC users (P=0.0007); among those of Hispanic ethnicity, 27.7% were MPC users vs. 26.2% which were non-MPC users (P=0.0094). Multiple logistic regression showed that poverty made a patient 6.7% more likely to use MPC (P=0.0072), while being male makes a patient 13.1% less likely of MPC use (P<0.0001). IMPLICATIONS: As expected, MPC users skew more female, white, & young compared to all patients. However, contrary to our hypotheses, under-served populations (as a function of encounter coverage type, race, preferred language and ethnicity) are not under-represented when it comes to MPC usage, and in some cases show incremental gains in total percentage when compared with non-MPC users. Logistic regression corroborates this finding, determining poverty (a constructed variable aggregating Medicaid, self-pay and uninsured insurance types) to be a statistically significant predictor of MPC usage.