"I Want to Keep the Personal Relationship With My Doctor": Understanding Barriers to Portal Use among African Americans and Latinos
"I Want to Keep the Personal Relationship With My Doctor": Understanding Barriers to Portal Use among African Americans and Latinos
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DOI：
10.2196/jmir.5910
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发表时间：
2016-10-01
影响因子：
7.4
通讯作者：
Garrido, Terhilda
中科院分区：
文献类型：
--
作者：
Lyles, Courtney Rees;Allen, Jill Y.;Garrido, Terhilda
背景：尽管电子健康记录(EHR)得到广泛应用，但越来越多的证据表明，少数族裔患者不像非西班牙裔白人那样频繁地使用门户网站在线访问他们的EHR信息。这种不同的门户使用可能是医疗保健差异的问题，因为早期证据表明门户使用与更好的结果有关。目标：我们试图了解Kaiser Permanente非裔和拉丁裔患者使用门户的具体障碍，以及患者群体的广泛接受。方法：2012年和2013年，我们在大西洋中部、佐治亚州和南加州地区的非裔和拉丁裔Kaiser Permanente成员中进行了10个焦点小组，有87名参与者。如果成员没有注册门户访问，他们就有资格参加。在每个种族/族裔群体内进行了重点小组，每个小组都包括年龄较大、患有慢性病或为人父母的个人(因为这些人是Kaiser Permanente门户网站的三个最大用户)。我们将每个焦点小组都录了下来，并将讨论内容转录下来进行分析。结果：我们发现，在我们的样本中，缺乏支持是启动门户使用的关键障碍--无论是在技术援助方面，还是在担心门户侵蚀与医疗保健提供者现有的个人关系方面。这在代表年龄、收入、健康状况和地理区域的一系列焦点群体中都是正确的。结论：我们的研究是对种族/民族亚群中门户网站使用障碍的首批定性探索之一。我们的发现表明，在不同的患者群体中统一采用门户网站需要更多的可用和个性化的网站，这可能对减少医疗保健差异特别重要。这项工作尤其重要，因为所有医疗保健系统继续通过门户网站在线提供和推广更多的医疗保健功能。
Background: Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes.Objective: We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large.Methods: We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group.Results: We found that lack of support was a key barrier to initiating portal use in our sample-both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions.Conclusions: Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for reducing health care disparities. This work is particularly important as all health care systems continue to offer and promote more health care features online via portals.