• Courtney R Lyles, Lina Tieu, Urmimala Sarkar, Stephen Kiyoi, Shobha Sadasivaiah, Mekhala Hoskote, Neda Ratanawongsa, and 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). courtney.lyles@ucsf.edu.
• J Am Board Fam Med. 2019 Mar 1; 32 (2): 248258248-258.

BackgroundPatient portals are becoming ubiquitous. Previous research has documented substantial barriers, especially among vulnerable patient subgroups such as those with lower socioeconomic status or limited health literacy (LHL). We tested the effectiveness of delivering online, video-based portal training to patients in a safety net setting.MethodsWe created an online video curriculum about accessing the San Francisco Health Network portal, and then randomized 93 English-speaking patients with 1+ chronic diseases to receive 1) an in-person tutorial with a research assistant, or 2) a link to view the videos on their own. We also examined a third, nonrandomized usual care comparison group. The primary outcome was portal log-in (yes/no) 3 to 6 months post-training, assessed via the electronic health record. Secondary outcomes were self-reported attitudes and skills collected via baseline and follow-up surveys.ResultsMean age was 54 years, 51% had LHL, 60% were nonwhite, 52% were female, 45% reported fair/poor health, and 76% reported daily Internet use. At followup, 21% logged into the portal, with no differences by arm (P = .41), but this was higher than the overall clinic rate of 9% (P < .01) during the same time period. We found significant prepost improvements in self-rated portal skills (P = .03) and eHealth literacy (P < .01). Those with LHL were less likely to log in post-training (P < .01).ConclusionsBoth modalities of online training were comparable, and neither mode enabled a majority of vulnerable patients to use portals, especially those with LHL. This suggests that portal training will need to be more intensive or portals need improved usability to meaningfully increase use among diverse patients.© Copyright 2019 by the American Board of Family Medicine.

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