Access policy and the digital divide in patient access to medical records
Access policy and the digital divide in patient access to medical records
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DOI：
10.1016/j.hlpt.2016.11.004
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发表时间：
2017-03-01
影响因子：
6
通讯作者：
Calman, Neil
中科院分区：
文献类型：
--
作者：
Ancker, Jessica S.;Nosal, Sarah;Calman, Neil
背景：患者获取医疗记录可以帮助他们管理自己的医疗保健。在早期采用患者门户时发现社会经济差异后，安全网医疗组织实施了通用访问政策、移动门户应用程序和西班牙语版本。本研究的目的是估计变化对使用患者门户的社会经济差异的影响。方法：对 2011 年至 2014 年访问家庭健康研究所的 129,738 名成年患者进行回顾性队列研究。使用逻辑回归对接收门户访问和使用门户的几率进行建模。结果：2011 年，社会经济弱势群体的成员不太可能收到使用门户的提议并随后使用它。 2014 年，黑人患者与其他种族群体一样有可能使用该门户网站，但公共保险和未保险患者成为用户的可能性仍然较小。移动应用程序的使用速度很慢。结论：用普遍访问政策取代选择加入政策与访问和不访问其医疗记录的人之间的社会经济差距大幅缩小有关。然而，在该技术的使用中仍然存在明显的小数字鸿沟，这可能是由于医疗保健系统无法控制的结构性因素，例如不太富裕的患者缺乏计算机访问权限。 (C) 2017 年研究生医学奖学金。由爱思唯尔有限公司出版。保留所有权利。
Background: Patient access to medical records may help them manage their healthcare. After socioeconomic disparities were found in early adoption of a patient portal, a safety net medical organization implemented universal access policies, a mobile portal app, and a Spanish version. The objective of this study was to estimate the effect of the changes on socioeconomic disparities in use of the patient portal.Methods: Retrospective cohort study of 129,738 adult patients visiting the Institute for Family Health between 2011 and 2014. Logistic regression was used to model the odds of receiving portal access and using the portal.Results: In 2011, members of socioeconomically disadvantaged groups were less likely to receive offers to use the portal and subsequently to use it. In 2014, black patients became just as likely as other racial groups to use the portal, but publicly insured and uninsured patients were still less likely to become users. Uptake of the mobile app was slow.Conclusions: Replacing an opt-in policy with a universal access policy was associated with a large reduction in socioeconomic disparities between those who did and did not access their medical records. However, a small digital divide remained evident in use of the technology, probably due to structural factors beyond the control of the healthcare system such as lack of computer access by less affluent patients. (C) 2017 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. All rights reserved.