Photo Credit: John Kevin

Digital portals enhance communication and interventions for hypertension management in primary care, but recent research highlights significant disparities.

Among primary care management for hypertension, patient portals have emerged as a significant tool for enhancing patient-clinician communication and implementing interventions aimed at blood pressure control, according to a study published online in JAMA Network Open. This cohort study included 366,871 patients from a large Midwestern healthcare system and investigated the disparities in engagement with patient portals among patients with hypertension.

The study revealed notable disparities despite the general availability and automatic provision of access codes for patient portals. Non-Hispanic Black and Hispanic patients had significantly lower odds of accessing the patient portal at all, with odds ratios (ORs) of 0.53 and 0.66, respectively, compared to non-Hispanic White patients. The authors observed similar trends in engagement with primary care physician (PCP) visits, frequent access, and messaging via the portal. Patients whose preferred language is not English and those without insurance were also less likely to engage with the portal. Tobacco users exhibited lower engagement across all measures, highlighting the intersection of social determinants of health and digital engagement.

Improving Patient Engagement

The results suggest that the reliance on patient portals for delivering hypertension-related interventions could inadvertently widen existing health disparities. The study’s findings underscore healthcare systems’ need to make concerted efforts to engage disadvantaged patient groups. For example, patients with frequent PCP visits showed higher engagement with patient portals, indicating that increased touchpoints with healthcare providers could foster greater portal use. This highlights the potential role of care teams in actively promoting portal use during in-person visits.

Clinical characteristics also played a role in portal engagement. Patients with comorbid conditions like diabetes and depression were generally less likely to access the portal, though they engaged more in messaging and home blood pressure monitoring once they did. This suggests that while initial portal access might be lower among these groups, those who engage may find significant value in the functionalities offered.

The study analyzed electronic health records (EHRs) and patient portal log data, focusing on patients who had at least one primary care visit in 2021. Engagement was measured through several indicators, including portal access, frequent access, messaging, and sharing home blood pressure readings. The comprehensive nature of the dataset and the use of multivariable logistic regression to adjust for potential confounders strengthen the validity of the findings.

The Next Steps

The implications of this study are profound. As patient portals become more integral to hypertension management, healthcare systems must address the digital divide. This can be achieved through targeted interventions such as culturally and linguistically appropriate educational materials, enhanced support for portal use, and proactive outreach by care teams. Furthermore, integrating socioeconomic factors and internet access into the EHR could provide a more nuanced understanding of the barriers to portal engagement and help tailor interventions more effectively.

Although patient portals could improve hypertension management, their benefits are not equally distributed. This study highlights the critical need for healthcare systems to address the disparities in digital health engagement to ensure that all patients, regardless of race, ethnicity, insurance status, or language preference, can benefit from these technological advancements. Continued research and innovative approaches are essential to bridging the digital divide and improving health outcomes for all patients with hypertension.