Results from a recent study published in the Clinical Journal of the American Society of Nephrology (CJASN) found that patients with kidney disease show disparities in their access to e-health resources. According to researchers, such discrepancies may reinforce or enlarge existing health-related inequities associated with income and race.
Enabling kidney disease patients to easily use an Internet site as a portal to access their medical data and communicate with their care providers could help patients better understand their disease and follow the providers’ advice. Still, there are substantial inequalities in health outcomes among patients with chronic kidney disease (CKD) associated with socioeconomic status and race. Specialists worry that disparities in patients’ adoption of web portals could make matters worse. “Understanding how these technologies are used, by whom, and how it associates with outcomes in the setting of CKD may stimulate interventions to ensure more equitable access and use of these resources,” said study author Khaled Abdel-Kader, MD, MS (Vanderbilt University).
In the paper entitled “Disparities in Electronic Health Record Patient Portal Use in Nephrology Clinics”, Dr. Abdel-Kader, Manisha Jhamb, MD, MPH (University of Pittsburgh), and co-workers investigated this issue by describing adoption of an electronic health record portal among a sample of 2,803 patients from 2010 to 2012 across four university-affiliated nephrology offices. Researchers determined that older age, black race, Medicaid/Medicare insurance status, and lower neighborhood average household income were each associated with lower rates of portal adoption. The results specifically revealed that, when compared to privately insured patients, Medicaid patients were 47% less likely to access the portal; African-Americans were 50% less likely to access the portal in comparison to non-African Americans; and 80-year-olds had a 71% lower likelihood (vs. 40-year-old patients) of accessing the portal.
The researchers found that portal adoption has increased in recent years (2011, 2012 versus. 2010), however the results showed that disparities in adoption remained. The researchers also found evidence that patients who used the portal were more likely to have their blood pressure under control. “Unfortunately, in the setting of CKD, it appears that black patients and patients of lower socioeconomic status are often left behind when it comes to using these technologies,” said Dr. Abdel-Kader. “Additional studies are needed to uncover the barriers that underserved CKD patients may face concerning the use of e-health technologies, and to develop ways to address them.”
In an accompanying editorial, Mallika Mendu, MD, MBA (Brigham and Women’s Hospital) and her colleagues noted that “the study shows that portals could perversely widen existing disparities in care by advantaging those who are already at an advantage, while not helping the disadvantaged. To prevent additional inequities in the delivery of care for a condition where disparities already exist requires strategies that are inclusive of vulnerable patient populations.”