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Research ArticleOriginal Research

A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal

Courtney R. Lyles, Lina Tieu, Urmimala Sarkar, Stephen Kiyoi, Shobha Sadasivaiah, Mekhala Hoskote, Neda Ratanawongsa and Dean Schillinger
The Journal of the American Board of Family Medicine March 2019, 32 (2) 248-258; DOI: https://doi.org/10.3122/jabfm.2019.02.180263
Courtney R. Lyles
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
PhD
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Lina Tieu
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MPH
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Urmimala Sarkar
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MD, MPH
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Stephen Kiyoi
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MLIS, MS
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Shobha Sadasivaiah
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MD
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Mekhala Hoskote
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
BA
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Neda Ratanawongsa
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MD, MPH
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Dean Schillinger
From the Center for Vulnerable Populations (CRL, LT, US, MH, NR, DS), Division of General Internal Medicine (CRL, LT, US, MH, NR, DS), UCSF Division of Hospital Medicine (SS), Zuckerberg San Francisco General Hospital Library (SK), University of California–San Francisco, San Francisco, CA; Jonathan and Karin Fielding School of Public Health, University of California–Los Angeles, Los Angeles (LT); Office of Health Informatics, San Francisco Health Network, San Francisco (SS).
MD
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Article Figures & Data

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    Figure 1.

    Trial recruitment flowchart.

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    Figure 2.

    Portal initiation and use at 3–6 month followup, comparing trial participants to usual care comparison group.

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    Figure 3.

    Rates of portal use at 3–6 month followup by key patient demographics and health characteristics.

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    Table 1.

    Baseline Participant Characteristics, Overall and by Trial Arm

    VariableOverall (n = 93)Take-Home Training Arm (n = 49)In-Person Training Arm (n = 44)P-value (t-test or χ2 test)
    Age, mean (SD)54.3 (13)52.5 (14)56.3 (10).14
    Gender, n (%).48
        Female48 (52)25 (51)23 (52)
    Race/ethnicity, n (%).79
        White or Caucasian35 (39)17 (35)18 (41)
        African American or Black26 (29)15 (27)11 (30)
        Hispanic/Latino11 (12)7 (14)4 (9)
        Asian or Pacific Islander12 (14)6 (12)6 (14)
        Other/mixed5 (6)4 (8)1 (2)
    Health Literacy*, n (%).84
        Limited47 (51)25 (52)22 (50)
        Adequate45 (49)23 (48)22 (50)
    English Proficiency†, n (%).56
        Limited23 (25)12 (25)10 (23)
        Advanced69 (75)36 (74)33 (75)
    Self-Rated Health Status, n (%).73
        Fair or poor41 (45)21 (43)20 (47)
    Chronic condition, n (%)
        Hypertension50 (58)28 (57)22 (50).49
        Depression36 (42)20 (41)16 (36).66
        Diabetes33 (38)16 (33)17 (39).55
        Anxiety31 (36)22 (45)9 (21).01
        Asthma or COPD21 (23)11 (22)10 (23).97
        Heart Disease8 (9)5 (10)3 (7).56
        Heart Failure6 (6)4 (8)2 (5).48
        Chronic kidney disease6 (7)2 (4)4 (9).42
    Frequency of Internet use, n (%).57
        Daily71 (76)36 (75)35 (80)
        Weekly14 (15)9 (19)5 (11)
        Every 2 to 3 weeks or less7 (8)3 (6)4 (9)
    • COPD, Chronic Obstructive Pulmonary Disease; SD, standard deviation.

    • ↵* Limited health literacy categorized as any self-reported lack of confidence (less than extremely confident) filling out medical forms on own.

    • ↵† Limited English proficiency categorized as any self-reported limitation in speaking English (less than very well).

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    Table 2.

    Primary Trial Outcomes: Portal Initiation and Use at 3–6-Month Followup Assessed via Electronic Health Record

    In-Person Training Arm (n = 44)Take-Home Training Arm (n = 49)P-Value (χ2 tests)
    Intention to Treat Analysis: Comparison by Trial Arm, n (%)
        Accessed training curriculum44 (100)21 (43)<.001
        Initiated sign-up for portal in clinic8 (19)9 (20).9
        Logged into portal Web site9 (21)9 (20).8
    Accessed Training (n = 65)Did Not Access Training (n = 28)P-Value (χ2 tests)
    Per Protocol Analysis: Comparison by Exposure to Portal Training, n (%)
        Initiated sign-up for portal in clinic12 (20)5 (19)1.0
        Logged into portal Web site14 (23)4 (15)0.4
    • Overall participants: n = 93, including access to online training curriculum.

    • Portal use outcomes (initiation and log-ins): n = 88.

    • View popup
    Table 3.

    Changes in Participants' Self-Reported Survey Measures from Baseline to Followup at 3 to 6 Months Post-Training

    VariableBaseline Survey: N (%) or Mean (SD)Follow-up Survey: N (%) or Mean (SD)P-Value (paired t-test or McNemar's test)
    Interest/attitudes related to portal use
        Internet is useful for health decisions*47 (65)54 (75).18
    Important to get personal medical information electronically†71 (95)70 (93)1.00
        Confident in portal safeguards/privacy‡60 (80)57 (76).44
        High interest in using MYSFHEALTH portal to see personal medical record§53 (72)39 (53).01
    High interest in potential portal features‖
        Appointment reminders55 (73)56 (75).82
        General health information36 (48)42 (56).22
        Medication reminders43 (57)43 (56).83
        Lab/test results62 (83)59 (79).44
    Skills for Portal Use
    Self-reported skills to use portal Web site¶46 (63)57 (78).03
        High confidence in using MYSFHEALTH without help#47 (67)54 (77).11
        High confidence in using MYSFHEALTH to improve health#44 (63)41 (58).53
    eHealth Literacy (eHeals**)14.4 (3.7)16.2 (2.4)<.001
    Self-reported Chronic Disease Management
        Patient Assessment of Chronic Illness Care††3.2 (1.0)3.2 (0.9).72
        Self-Efficacy for Managing Chronic Disease‡‡6.3 (1.9)6.7 (2.0).10
    • MYSFHEALTH, the name of the online patient portal investigated in this trial; SD, standard devation.

    • Sample size is n = 75 with complete data at both time points.

    • ↵* Usefulness categorized as very useful/useful vs. neutral/not useful/not at all useful.

    • ↵† Importance categorized as very/somewhat vs. not at all important.

    • ↵‡ Confidence in safeguards categorized as very/somewhat vs. not confident.

    • ↵§ Interest in portal categorized as high interest vs. low/neutral/moderate/none/need more information.

    • ↵‖ Interest in portal features categorized as high interest vs. somewhat/a little/not at all interested.

    • ↵¶ Skills categorized as strongly agree/agree vs. neutral/disagree/strongly disagree.

    • ↵# Confidence in using portal without help and to improve health categorized as 8 to 10 vs. 1 to 7.

    • ↵** eHeals score calculated using 4 of 8 eHeals questions; range, 4 to 20 with higher score noting higher perceived eHealth literacy.

    • ↵†† Patient Assessment of Chronic Illness Care Survey; range, 1 to 5 with higher score noting higher ratings of chronic illness scare.

    • ↵‡‡ Self-Efficacy for Managing Chronic Disease Scale; range, 1 to 10 with higher score noting higher self-efficacy.

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The Journal of the American Board of Family     Medicine: 32 (2)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 2
March-April 2019
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A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal
Courtney R. Lyles, Lina Tieu, Urmimala Sarkar, Stephen Kiyoi, Shobha Sadasivaiah, Mekhala Hoskote, Neda Ratanawongsa, Dean Schillinger
The Journal of the American Board of Family Medicine Mar 2019, 32 (2) 248-258; DOI: 10.3122/jabfm.2019.02.180263

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A Randomized Trial to Train Vulnerable Primary Care Patients to Use a Patient Portal
Courtney R. Lyles, Lina Tieu, Urmimala Sarkar, Stephen Kiyoi, Shobha Sadasivaiah, Mekhala Hoskote, Neda Ratanawongsa, Dean Schillinger
The Journal of the American Board of Family Medicine Mar 2019, 32 (2) 248-258; DOI: 10.3122/jabfm.2019.02.180263
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