• Elston LafataJenniferJUNC Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Ln, 2214 Kerr Hall, CB #7573, Chapel Hill, NC 27599. Email: jel@mail.unc.edu., Carrie A Miller, Deirdre A Shires, Karen Dyer, Scott M Ratliff, and Michelle Schreiber.
• UNC Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Ln, 2214 Kerr Hall, CB #7573, Chapel Hill, NC 27599. Email: jel@mail.unc.edu.
• Am J Manag Care. 2018 Nov 1; 24 (11): e352-e357.

ObjectivesWe describe online portal account adoption and feature access among subgroups of patients who traditionally have been disadvantaged or represent those with high healthcare needs.Study DesignRetrospective cohort study of insured primary care patients 18 years and older (N = 20,282) receiving care from an integrated health system.MethodsUsing data from an electronic health record repository, portal adoption was defined by 1 or more online sessions. Feature access (ie, messaging, appointment management, visit/admission summaries, and medical record access and management) was defined by user-initiated "clicks." Multivariable regression methods were used to identify patient factors associated with portal adoption and feature access among adopters.ResultsOne-third of patients were portal adopters, with African Americans (odds ratio [OR], 0.50; 95% CI, 0.46-0.56), Hispanics (OR, 0.63; 95% CI, 0.47-0.84), those 70 years and older (OR, 0.48; 95% CI, 0.44-0.52), and those preferring a language other than English (OR, 0.43; 95% CI, 0.31-0.59) less likely to be adopters. On the other hand, the likelihood of portal adoption increased with a higher number of comorbidities (OR, 1.04; 95% CI, 1.02-1.07). Among adopters, record access and management features (95.9%) were accessed most commonly. The majority of adopters also accessed appointment management (76.6%) and messaging (59.1%) features. Similar race and age disparities were found in feature access among adopters.ConclusionsThe diversity of portal features accessed may bode well for the ability of portals to engage some patients, but without purposeful intervention, reliance on portals alone for patient engagement may exacerbate known social disparities-even among those with an activated portal account.

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