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What are Facilitators and Barriers to Older Patient Portal Use?

Understanding facilitators and barriers to older patient portal use can inform better strategies going forward.

older patient portal use

Source: Thinkstock

By Sara Heath

- Patients over the age of 65 have security and usability concerns that limit patient portal use, but having a doctor or family member help them with the tool can be a portal facilitator, according to a study in the Journal of Medical Internet Research.

The medical field is seeing an influx of older patients as the Baby Boomers mature into the Medicare age bracket.

The industry is expected to continue on this trend. In 2014, there were 42.5 million older patients in the US, a figure that is estimated to skyrocket to 98 million by 2060, the researchers reported.

Older patients tend to have more complex health needs and chronic care issues that must be managed. Health IT, such as patient portals and electronic personal health records (ePHRs), have potential in this area.

“There has been a growing interest in the design of technologies for older adults, including technologies that can support older adults through health maintenance and health information management,” the research team said. “Such technologies have the potential to support older adults by allowing them to age in their own homes, maintain their health, and provide a sense of autonomy.”

However, there are inconclusive views about older patient portal use, a limited area of study, the researchers said. Research about older patient portal use could better inform clinician motivation and adoption strategy as well as developer design strategy, the researchers posited.

“It is a leap to assume that patient portals and ePHRs, as they are currently designed and used, will effectively address the health information needs of the older adult population,” the investigators stated. “It is important to first understand the facilitators of and barriers to older adult use and adoption of health-related technology.”

The team sought to determine older patient attitudes toward the portal through a literature review of 17 articles published between 2006 and 2016.

The literature review revealed two primary barriers and two facilitators for older patient portal use. Among the numerous barriers identified, security concerns and issues surrounding access to and ability to use patient portals presented as most pervasive.

Patients expressed concern about how data would be stored and used in the portal, but did not reveal any strategic insight.

“Papers consistently described privacy and security issues,” the researchers reported. “However, there were not many specific suggestions for making older adults feel secure, and there were no design suggestions from older adults about what would make them trust the security of a system.”

Going forward, more research must be done to determine specific patient portal security concerns. Additionally, researchers should look into patient-provider communication strategies that could assuage patient security fears.

Worries about access to and ability to use health technology were also pressing. These concerns disproportionately affected low-income patient populations.

Most studies focused on barriers to older patient portal use, the researchers said. However, technical assistance and family and provider advice and advocacy emerged as two large portal use facilitators.

Assistance needs to be prolonged to have a noticeable effect on patient portal adoption, the team observed.

Patients are more likely to try the patient portal at their provider’s recommendation, but after that providers have limited influence on patient behavior. Patients with strong familial support were instead more likely to have prolonged patient portal use.

The literature review also included an analysis of patient experiences with the patient portal, finding that patients generally enjoy using the patient portal. Patients primarily favor health information management functions, such as patient data access, lab results access, and medication management.

Patients reportedly want the ability to send some of their information to another individual, such as a family caregiver. Additionally, patients expressed a desire for more reminders, lifestyle tips, and claims management assistance.

“Although studies in this review captured overall user experience, there is room for more exploration to better understand older adults’ experience with and use of patient portals and ePHRs,” the researchers said, noting that this information could inform future system development.

“Research could focus on usability by learning about participants’ expectations and navigation of systems,” the team added. “This information could then provide designers with necessary feedback to make iterative improvements to particular systems.”

Further research can also explore the role of patient portal design in addressing patient portal use barriers and facilitators, the team concluded.

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