Abstract
BackgroundGood communication has been shown to affect patient outcomes; however, the effect varies according to patient and clinician characteristics. To date, no research has explored the differences in the content of secure messages based on these characteristics.ObjectiveThis study aims to explore characteristics of patients and clinic staff associated with the content exchanged in secure messages.MethodsWe coded 18,309 messages that were part of threads initiated by 1031 patients with hypertension, diabetes, or both conditions, in communication with 711 staff members. We conducted four sets of analyses to identify associations between patient characteristics and the types of messages they sent, staff characteristics and the types of messages they sent, staff characteristics and the types of messages patients sent to them, and patient characteristics and the types of messages they received from staff. Logistic regression was used to estimate the strength of the associations.ResultsWe found that younger patients had reduced odds of sharing clinical updates (odds ratio [OR] 0.77, 95% CI 0.65-0.91) and requesting prescription refills (OR 0.77, 95% CI 0.65-0.90). Women had reduced odds of self-reporting biometrics (OR 0.78, 95% CI 0.62-0.98) but greater odds of responding to a clinician (OR 1.20, 95% CI 1.02-1.42) and seeking medical guidance (OR 1.19, 95% CI 1.01-1.40). Compared with White patients, Black patients had greater odds of requesting preventive care (OR 2.68, 95% CI 1.30-5.51) but reduced odds of requesting a new or changed prescription (OR 0.72, 95% CI 0.53-0.98) or laboratory or other diagnostic procedures (OR 0.66, 95% CI 0.46-0.95). Staff had lower odds of sharing medical guidance with younger patients (OR 0.83, 95% CI 0.69-1.00) and uninsured patients (OR 0.21, 95% CI 0.06-0.73) but had greater odds of sharing medical guidance with patients with public payers (OR 2.03, 95% CI 1.26-3.25) compared with patients with private payers. Staff had reduced odds of confirming to women that their requests were fulfilled (OR 0.82, 95% CI 0.69-0.98). Compared with physicians, nurse practitioners had greater odds of sharing medical guidance with patients (OR 2.74, 95% CI 1.12-6.68) and receiving prescription refill requests (OR 3.39, 95% CI 1.49-7.71). Registered nurses had greater odds of deferred information sharing (OR 1.61, 95% CI 1.04-2.49) and receiving responses to messages (OR 3.93, 95% CI 2.18-7.11) than physicians.ConclusionsThe differences we found in content use based on patient characteristics could lead to the exacerbation of health disparities when content is associated with health outcomes. Disparities in the content of secure messages could exacerbate disparities in patient outcomes, such as satisfaction, trust in the system, self-care, and health outcomes. Staff and administrators should evaluate how secure messaging is used to ensure that disparities in care are not perpetuated via this communication modality.
Highlights
BackgroundAppropriate use of health information technology may promote patient engagement and empowerment by improving patients’ preparation for, and recall of, clinical encounters [1]
The differences we found in content use based on patient characteristics could lead to the exacerbation of health disparities when content is associated with health outcomes
Given that other research demonstrated that secure message content was associated with selected health outcomes [28], our findings may indicate that inequitable use of secure messaging could further compound existing disparities in health care delivery and outcomes
Summary
BackgroundAppropriate use of health information technology may promote patient engagement and empowerment by improving patients’ preparation for, and recall of, clinical encounters [1]. One form of health information technology is secure messaging—the electronic exchange of messages between patients and clinicians, typically via a secure platform such as a patient portal. Published research highlights the potential of secure messaging to support patient satisfaction, access to care, and health outcomes. Most research has explored health care utilization, with a number of studies identifying reductions in patients’ visits associated with secure messaging [2,3,4]. Other studies have identified improvements in selected measures for screening and testing associated with secure messaging use [5,6,7]. No research has explored the differences in the content of secure messages based on these characteristics
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