Reducing health disparities in primary care through a family medicine-library alliance

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PROJECT SUMMARY/ABSTRACT Rapid advances in the internet and technology have greatly changed how health information is accessed and communicated. Reports indicate that internet access is increasing nationwide and greater access to health information online has been linked to improved health knowledge and patient-provider communication (PPC). In addition to generalized Web-access, availability and use of electronic personal health records (PHR) offers a patient-centric means of improving patient investment in their health, PPC, and ultimately the quality of care. Empirical evidence of benefits from PHR-enhanced care is strongest for patients with chronic diseases requiring self-management, such as diabetes and hypertension, conditions that are disproportionately borne by underserved minority populations and that contribute to persistent health disparities. Despite these benefits, evidence also suggests that a digital divide (i.e., inequitable access and disparities in the use of technology) still exists among the lower socioeconomic status, racial/ethnic minority, and other medically underserved populations. This divide limits comprehensibility and access to accurate health information and hinders effective health decision making. Also, despite high smartphone ownership, frequent access of the Internet via smartphones, and increased interest in access to PHRs across racial/ethnic groups—nonwhites remain significantly less likely to register for and utilize electronic PHRs. To address these health disparities, we propose an innovative partnership between Baylor College of Medicine’s (BCM) Martin Luther King, Jr. (MLK) Health Center and a prominent health sciences library, the Houston Academy of Medicine-Texas Medical Center (HAM-TMC) Library. The MLK Health Center serves over 40,000 patients each year, primarily African- American adults residing in central Harris County, Houston, TX. The HAM-TMC library is one of the nation’s largest libraries and has been designated as a Regional Medical Library by the National Library of Medicine. Through this alliance, the project will address influential factors in patients’ access, use, and understandability of health information, and will be guided by the following specific aims: Aim 1: To improve patients’ knowledge, attitudes, and skills in using reliable, up-to-date health information from the Web to manage their care; Aim 2: To establish an on-site ‘health information learning center’ to increase access to high-quality, targeted health information at the point of care; and Aim 3: To increase patients’ mastery and confidence in using MyChart to access PHRs and engage in ongoing, asynchronous communication with providers between care encounters. This proposals’ significance and opportunity for change is exemplified by the fact that most MLK patients have limited access to relevant health information online and approximately 10% use MyChart, compared to nearly 90% usage at a private BCM family medicine clinic within the same city, despite MLK having a higher prevalence of multiple chronic conditions necessitating self-care management. Our approach can be replicated or adapted to address health disparities in other underserved primary care settings.