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New study indicates online health tools may contribute to health disparities

E-health interventions may be widening health disparities rather than shrinking them.

That’s what a study published in the Clinical Journal of the American Society of Nephrology found. The study looked at roughly 2,800 patients at four university-affiliated nephrology offices in western Pennsylvania from 2010 to 2012. The findings showed that patients who were poor, black, older, unmarried or on Medicare or Medicaid were less likely to use electronic health record portals to manage their chronic kidney disease.

The online portal the patients had access to gave them the ability to look at lab results, communicate with their providers, get prescription refills, review their medical information and schedule or change appointments.

But of the almost 40% of patients who used the portal, those patients were most likely to be white, married, young, on private insurance and with a higher neighborhood median household income.

“Despite the increasing availability of smartphones and other technologies to access the Internet, the adoption of e-health technologies does not appear to be equitable,” Khaled Abdel-Kader, M.D., senior author of the study and assistant professor of medicine at Vanderbilt University, told NPR. “As we feel we are advancing, we may actually perversely be reinforcing disparities that we had been making progress on.”

Abdel-Kader added that previous studies — including one that looked at patients with diabetes — have found similar results in which underserved patients and populations are less likely to use patient portals.

He told NPR that he believes the solution lies in understanding why people aren’t using the portals and to make sure they have tools that work for them.

In the case of this recent study that Abdel-Kader helped write, he believes possible obstacles that kept patients from using the portal include lack of confidence and skills in accessing health information online, low comfort level of communication with their provider via the portal and security concerns.

Mallika Mendu, attending physician and director of quality and process improvement in the renal division at Brigham and Women’s Hospital in Boston, told NPR that the potential for making existing health disparities even worse should be “panic inducing,” especially because many people in vulnerable and underserved populations deal with chronic disease.

Mendu thinks that people from underserved populations therefore need to play a role in the design of these e-health interventions and technologies. She also suggests that providers work to understand their patient population before creating these tools by surveying patients ahead of time to figure out how they access the Internet, whether patients are willing to receive training and what types of technologies they like to use.