Patient Portal Use and Blood Pressure Control in Newly Diagnosed Hypertension

William Manard; Jeffrey F. Scherrer; Joanne Salas; F. David Schneider

doi:10.3122/jabfm.2016.04.160008

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Table 1.

Distribution of Sociodemographics, Covariates, and Incident Blood Pressure Control Among Adult Primary Care Patients with Treated Hypertension and Uncontrolled Blood Pressure at Baseline (2008–2010), by Patient Portal Use During the Follow-up Period (2011–2015) (N = 1571)

Variable	Total Cohort (N = 1571)	Patient Portal Nonusers (n = 1171)	Patient Portal Users (n = 400)	P Value
Blood pressure control (yes)	1425 (90.7)	1045 (89.2)	380 (95.0)	.001
Age (years), mean (SD)	64.1 (13.3)	65.1 (13.5)	60.9 (12.2)	<.0001
Nonwhite race	931 (59.3)	819 (69.9)	112 (28.0)	<.0001
Female sex	988 (62.9)	726 (62.0)	262 (65.5)	.211
Married	632 (40.2)	401 (34.2)	231 (57.7)	<.0001
SES index (by zip code)				<.0001
Lowest	603 (38.4)	530 (45.3)	73 (18.2)
Lower-middle	347 (22.1)	271 (23.1)	76 (19.0)
Upper-middle	376 (23.9)	233 (19.9)	143 (35.8)
Highest	245 (15.6)	137 (11.7)	108 (27.0)
Clinic type¹				<.0001
GIM	1224 (77.9)	965 (82.4)	259 (64.8)
Family medicine	347 (22.1)	206 (17.6)	141 (35.2)
High clinic utilization	876 (55.8)	632 (54.0)	244 (61.0)	.015
Smoking status, 2008–2015				<.0001
Never	758 (48.3)	537 (45.9)	221 (55.2)
Former	403 (25.6)	295 (25.2)	108 (27.0)
Current	410 (26.1)	339 (28.9)	71 (17.8)
Depression	262 (16.7)	179 (15.3)	83 (20.8)	.011
Obesity	1051 (66.9)	772 (65.9)	279 (69.7)	.161
Comorbidity index, mean (SD)	2.1 (2.4)	2.3 (2.4)	1.6 (2.3)	<.0001

Data are n (%) unless otherwise indicated.
GIM, general internal medicine; SD, standard deviation; SES, socioeconomic status.

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Table 2.

Distribution of Sociodemographics and Covariates Among Adult Primary Care Patients with Treated Hypertension and Uncontrolled Blood Pressure at Baseline (2008–2010), by Patient Portal Use During the Follow-Up Period (2011–2015) (N = 1571)

Variable	No BP Control (n = 146)	BP Control (n = 1425)	P Value
Age (years), mean (SD)	59.8 (14.3)	64.5 (13.1)	<.0001
Nonwhite race	105 (71.9)	826 (58.0)	.001
Female sex	86 (58.9)	902 (63.3)	.295
Married	47 (32.2)	585 (41.1)	.038
SES index (by zip code)			.003
Lowest	76 (52.0)	527 (37.0)
Lower-middle	30 (20.6)	317 (22.3)
Upper-middle	25 (17.1)	351 (24.6)
Highest	15 (10.3)	230 (16.1)
Clinic type¹			.794
GIM	115 (78.8)	1109 (77.8)
Family Medicine	31 (21.2)	316 (22.2)
High clinic utilization	24 (16.4)	852 (59.8)	<.0001
Smoking status, 2008–2015			.023
Never	82 (56.2)	676 (47.4)
Former	24 (16.4)	379 (26.6)
Current	40 (27.4)	370 (26.0)
Depression	10 (6.8)	252 (17.7)	.001
Obesity	92 (63.0)	959 (67.3)	.295
Comorbidity index, mean (SD)	1.7 (2.0)	2.2 (2.5)	.007

Data are n (%) unless otherwise indicated.
BP, blood pressure; GIM, general internal medicine; SD, standard deviation; SES, socioeconomic status.

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Table 3.

Age-Adjusted Bivariate Associations of Patient Portal Use, Sociodemographics, and Covariates with Incident Blood Pressure Control Among Adult Primary Care Patients with Treated Hypertension and Uncontrolled Blood Pressure at Baseline (N = 1571)

Variable	Bivariate HR (95% CI)
Portal activity (yes)	1.24 (1.06–1.45)
Age (years)	0.92 (0.80–1.06)
Nonwhite race	0.79 (0.71–0.88)
Female sex	1.13 (1.02–1.26)
Married	1.12 (1.01–1.24)
SES index (by zip code)
Lowest	1.00
Lower-middle	1.11 (0.97–1.28)
Upper-middle	1.30 (1.14–1.49)
Highest	1.33 (1.14–1.55)
Clinic type¹
GIM	1.00
Family medicine	1.16 (1.02–1.31)
High clinic utilization	1.76 (1.58–1.96)
Smoking status, 2008–2015
Never	1.00
Former	1.12 (0.98–1.27)
Current	1.09 (0.96–1.24)
Depression	1.35 (1.16–1.58)
Obesity	1.07 (0.96–1.19)
Comorbidity index	1.01 (0.98–1.04)

CI, confidence interval; GIM, general internal medicine; HR, hazard ratio; SES, socioeconomic status.

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Table 4.

Association Between Patient Portal Use and Incident Blood Pressure Control Adjusting for Each Covariate in a Cohort of Adult Primary Care Patients with Treated Hypertension and Uncontrolled Blood Pressure at Baseline (N = 1571)

Model^*	Portal Activity, HR (95% CI)^{^†}
Base model (portal activity)	1.24 (1.06–1.45)
Base + race	1.13 (0.96–1.33)
Base + sex	1.14 (1.02–1.27)
Base + marital status	1.22 (1.04–1.43)
Base + SES index	1.16 (0.99–1.36)
Base + clinic type^{^‡}	1.13 (0.99–1.28)
Base + utilization	1.11 (0.95–1.30)
Base + smoking	1.24 (1.05–1.45)
Base + depression	1.23 (1.05–1.44)
Base + obesity	1.24 (1.06–1.45)
Base + comorbidity index	1.24 (1.06–1.46)
Base + race + gender + marital status + SES index + clinic type + utilization	0.98 (0.83–1.16)
Base + smoking + depression + obesity + comorbidity index	1.22 (1.04–1.44)
Base + all covariates	0.97 (0.82–1.15)

↵* All models are adjusted for age: age + age (squared) + age (cubed).
↵† All hazard ratios (HRs) and confidence intervals (CIs) were calculated using Cox proportional hazards models.
↵‡ Clinic types included general internal medicine and family medicine.
SES, socioeconomic status.