Background: Electronic patient-portals offer the potential to enhance patient-physician communication and health outcomes but differential use may create or worsen disparities. While prior studies identified patient characteristics associated with patient-portal use, the role of physician factors is less known. We investigated differences in overall and patterns of portal use for patients with resident and attending primary care providers (PCPs).
Methods: Cross-sectional study of all established patients with a resident or attending PCP seen at an academic internal medicine practice (two sites) between May 1, 2014, and April 30, 2015. We defined patient-portal use as having accessed any "active" (secure messaging, medication refill request), or "passive" (viewing labs, after visit summaries, or appointments) patient-portal function more than once over the study period. We used generalized linear models clustered on PCP to examine the odds of patient-portal use by PCP type, adjusted for patient age, gender, preferred language, race/ethnicity, insurance, and visits. Among patient-portal users, we examined the association of PCP type with "active use" utilizing the same method.
Results: The mean patient age (n = 17,699) was 54.2 (SD 17.5), with 47.2% White, 23.6% Asian, 8.8% Black, 8.4% Latino, and 12% other/unknown. The majority (61.8%) had private insurance, and attending PCPs (76.9%). Although 72.3% enrolled in the patient-portal, only 53.4% were portal users; 40.0% were active users. There were 47 attending and 62 resident physicians. Patients with resident PCPs had lower odds of using the portal compared to those with attending PCPs (OR = 0.54, 95% CI 0.50-0.59). Similarly, among portal users, residents' patients had lower odds of being active users of the portal (OR = 0.76, 95% CI 0.68-0.87).
Conclusion: Given the lower patient-portal use among residents' patients, residency programs should develop curricula to bolster trainee competence in using the patient-portal for communication and to enhance the patient-physician relationship. Future research should explore additional physician factors that impact portal use.
Keywords: disparities; patient-portal; physician-patient communication; resident training.