A Theory-Based Patient Portal eLearning Program for Older Adults with Chronic Illnesses

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Project Summary/Abstract The high prevalence of chronic illnesses is a serious public health problem in the U.S., and more than 70 million adults age ≥50 have at least one chronic illness. Management of chronic conditions requires long-term use of complex treatment plans and can cause unintended consequences, such as increased risk of medication errors. Patient portals (PPs), a federally supported health information technology (IT), can be especially helpful for patients with chronic illnesses. Patients can now access their own health records and directly communicate with care providers through PPs. Prior findings suggest a great potential for using PPs to improve care quality, and the federal government funds healthcare organizations to implement this tool nationwide (Meaningful Use incentive payment program). Despite the potential benefits, the overall PP adoption rate in the U.S. is low (26.8% in a 2014 national survey). A lack of PP use among older adults has been addressed as a particular concern. When only older adults who use the Internet are considered, however, their proportion of PP use is similar to other age groups. A few studies also reported that older adults are receptive to PPs.In general, older adults need additional support for learning to use PPs for their care management, as they tend to be less familiar with technology. Currently, most older adults receive little or no PP support from their providers. This is an important gap in the nation’s health IT initiative because without appropriate support, older adults will not be able to use this robust health tool, missing an important opportunity to improve their health outcomes. In an effort to fill this gap, in our preliminary study, we developed and tested an older adult friendly Theory-based Patient portal eLearning Program (T-PeP) to support older adults in using PPs for their care. In the proposed feasibility study, we plan to (Aim 1) optimize and implement a vendor- agnostic T-PeP and conduct formative and process evaluations (e.g., usability, facilitators/barriers); and (Aim 2) assess the preliminary impact of T-PeP on PP use and selected outcomes (PP knowledge, self-efficacy for PP use and health decision making, health communication, and medication reconciliation). A two-arm RCT will be conducted with older adults who have chronic conditions (N=242, age ≥50) and are recruited online. Data will be collected at baseline, the end of treatment (3 wks), and 4 months. Appropriate analytic approaches will address each study aim, including descriptive statistics, linear mixed models, and qualitative analyses. If successful, this study could directly affect quality of care provided to older adults and the success of the national health IT initiative. Findings from this study will also provide hospitals, vendors, and policymakers with in-depth information on older adults’current PP usage patterns and other challenges in using various types of PPs at the national level, contributing to the advancement of PP technology and changes in practice. In the next phase of the R01 study, we will test its long-term effects on health behaviors and clinical outcomes (e.g., improvement HbA1c) using more diverse samples, including practice settings and underserved populations.