Unlocking Digital Health: Inequalities in the adoption of a Patient Portal
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Objective
Digital health apps and patient portals are proposed as part of the drive from ‘analogue to digital’ care for the NHS 10 Year Plan. Without mitigation strategies, digital inequalities could arise as a result and more evidence is needed to understand how to mitigate this.
Methods
As part of an equalities impact assessment, a retrospective cross-sectional analysis was conducted examining patient portal activation among patients invited to outpatient appointments at two large south-east London Hospital Trusts between May 1st and November 1st, 2024.
Results
503,688 patients invited to attend outpatients during the study period, 52.7% of patients invited to attend outpatients had activated the patient portal. Availability of email contact details were strongest determinant for likelihood of onboarding (OR 10.86; CI 10.60-11.12). Multivariate logistic regression models showed the following groups were less likely to activate the patient portal. Men (odds ratio 0.84 (CI:0.83–0.85), extremes of age (71-80 years or 11-20 years), those mixed or undefined ethnicity OR 0.58 (CI 0.57– 0.59), black ethnicities OR 0.62 (CI 0.61–0.64) or un-recorded ethnicities OR 0.72 (CI 0.7– 0.74) and those with highest degree of socio-economically deprivation (IMD group 1) OR 0.68 (CI 0.65–0.72).
Conclusion
This large scale roll-out of a digital health portal provide empirical evidence of factors which drive digital inequalities for patients of two major London NHS Trusts. The observed disparities across demographic and socioeconomic dimensions and simple reliable digital contact mechanisms highlight the risk that digital healthcare initiatives may inadvertently produce new types of inequalities.
What is the paper about?
Were there inequalities in activation of the patient portal, MyChart, in the Apollo programme, by demographic characteristics of the patients? Yes. Table 1
Were the observed inequalities attributable to confounding? No. In a multivariate logistic regression, the inequalities persisted across all variables. Figure 1
Could the inequalities be explained by differential access to email and mobile phones across the groups? For several variables, adjusting for the presence of email address and mobile phone number attenuated the strength of the relationship with Patient Portal activation. It did not remove the effect for any variable and the relationship with ethnicity was barely affected. Figure 2
