Social Determinants of Health Associated With Patient Portal Use in Pediatric Diabetes

Rachel Parker; Ellen B Goldbloom; Nicholas Mitsakakis; Ivan Terekhov; Caroline Zuijdwijk

doi:10.1016/j.jcjd.2022.04.002

Social Determinants of Health Associated With Patient Portal Use in Pediatric Diabetes

Can J Diabetes. 2022 Aug;46(6):586-593. doi: 10.1016/j.jcjd.2022.04.002. Epub 2022 Apr 12.

Authors

Rachel Parker¹, Ellen B Goldbloom², Nicholas Mitsakakis³, Ivan Terekhov³, Caroline Zuijdwijk²

Affiliations

¹ Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: rparker@cheo.on.ca.
² Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada; Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.
³ Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada.

PMID: 35864034
DOI: 10.1016/j.jcjd.2022.04.002

Abstract

Objectives: Social determinants of health (SDOH) are associated with type 1 diabetes (T1D) outcomes. Patient portal (PP) use can improve care quality. Therefore, equitable PP access is essential. Associations between SDOH and PP access have not been reported in pediatric T1D. The purpose of this study was to determine whether PP access and use are associated with SDOH in pediatric T1D.

Methods: This work was a cross-sectional study of patients <18 years of age with T1D who were seen in a diabetes clinic at a tertiary care centre between April 1, 2020, and March 31, 2021. Patient postal code, PP activation status and use, and characteristics were collected from electronic health records on April 1, 2021. SDOH were assessed using patient postal code linked to the Ontario Marginalization Index (ON-Marg) to determine quintile score across 4 dimensions of deprivation. Statistical analysis tested for an association between PP activation status and ON-Marg quintile.

Results: Data were obtained for 634 patients with a mean age of 12.8±3.8 years; 53% were male and mean glycated hemoglobin was 8.4±2.0%. In the last year, 334 patients (53%) were PP active and 332 (52%) used the PP. The odds of inactive PP status were higher for those with the highest degree of material deprivation (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.62 to 5.36) and residential instability (OR, 3.49; 95% CI, 1.86 to 6.70). PP activation status was not associated with dependency or ethnic concentration.

Conclusions: In our pediatric T1D population, inactive PP status is associated with greater material deprivation and residential instability. How these factors impact PP activation and how to improve equitable access requires further study.

Keywords: diabète de type 1; digital divide; dossier médical électronique; déterminants sociaux de santé; electronic health record; fossé numérique; patient portal; portail des patients; social determinants of health; telemedicine; type 1 diabetes; télémédecine.

MeSH terms

Adolescent
Child
Cross-Sectional Studies
Diabetes Mellitus, Type 1* / complications
Female
Glycated Hemoglobin
Humans
Male
Patient Portals*
Social Determinants of Health

Substances

Glycated Hemoglobin A