AIM: PHR utilization splits along digital divide
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PHRs aim to increase patient access to personal health information, but widespread use will be difficult to achieve if patients cannot access this information because of a lack of Internet or computer access, wrote Cyrus K. Yamin, BS, of Brigham and Women’s Hospital, Harvard Medical School, Boston, and colleagues.
In the study, a cross-sectional analysis of PHR use within a health system in the Northeast United States, patients were categorized as adopters—those who activated a PHR account online; and nonadopters—patients who had visited a clinician at a practice offering PHR but did not have a PHR account.
A total of 75,056 patients were included, and as of Sept. 30, 2009, 32,274 had adopted a PHR since 2002. “Blacks and Hispanics were less likely to adopt the PHR compared with whites, and those with lower annual income were less likely to adopt the PHR than were those with higher income,” they stated.
Adopters were more likely than non-adopters to have more than two comorbidities. “Intensity of use was best predicted by increasing number of comorbidities, followed by race/ethnicity (whites more than blacks and Hispanics) and insurance status. We found no association between income and log-in frequency or secure messages sent,” they continued.
Among the adopters, the authors recorded 290,662 log-ins to the PHR system, and classified 51 percent of users as very low users, logging into the PHR one time or less in the previous two years. The second-largest group identified were categorized as high users (27 percent) and logged into the system 10 or more times.
Patients between the ages of 51 and 65 years composed the majority of the high-users group, at 41 percent. Patients older than 65 adopted a PHR to a greater extent than patients between 18 and 35 years of age, Yamin and colleagues found. Use of an aggressive marketing strategy for PHR enrollment increased adoption nearly three-fold, the authors observed.
“In this study, we found the presence of a digital divide in a diverse population. Specifically, racial/ethnic minorities and patients with lower socioeconomic status were less likely to adopt a PHR. However, both of these groups used the PHR as much as other groups if they were able to adopt it. Whether the digital divide was caused by barriers in access to technology or reflects long-standing disparities in health-seeking behavior is less clear. Further studies are needed to better understand and promote use of PHRs among adopters and to design interventions to increase PHR uptake among populations likely to benefit most,” the authors concluded.
The study was funded by Partners HealthCare Information Systems Research Council.