Trends in U.S. Consumers’ Use of E-Health Services: Fine-Grained Results from a Longitudinal, Demographic Survey

Although growth in U.S. consumers’ overall use of e-health is strong, it is being driven by only a portion of the e-health services that are offered through online health portals. Fine-grained, longitudinal analysis of three representative e-health services shows that, while online communication with medical personnel has grown consistently between 2003 and 2012, the purchase of health supplies online plateaued by 2007, and participation in online support groups has been flat since 2003. Socio-economic factors of income and education level continue to have an impact on consumers’ use of e-health; however, differences based on age, sex, and race/ethnicity are trending lower during this period. The findings caution against the common practice of studying e-health adoption principally at the level of online health portals, which can mask substantial variation in adoption trends among the underlying e-health services, and suggest that it is important to update trend studies on a regular basis to maintain currency

Equitable Healthcare Access During the Pandemic: The Impact of Digital Divide and Other SocioDemographic and Systemic Factors

Access to healthcare is a fundamental right for all individuals, and it has become more crucial than ever during the ongoing COVID-19 pandemic. Unfortunately, many people have faced barriers to accessing healthcare services due to the digital divide. The COVID-19 pandemic has brought into sharp focus the urgent need for access to healthcare services. The impact of the pandemic on healthcare access has been a matter of concern for policymakers, healthcare providers, and the public alike. This study aimed to empirically examine the determinants of healthcare access during the pandemic, with a specific focus on the impact of the digital divide. The sample size consisted of 312 individuals, and the study applied a multivariable regression model with HAC estimator to analyze the data. Healthcare access was the dependent variable, while the independent variables included Digital divide, Demographic factors, Sociocultural factors, and Systemic factors. The findings revealed that demographic factors, sociocultural factors, and systemic factors significantly impacted healthcare access during the pandemic. However, the most significant finding was the impact of the digital divide on healthcare access. This finding underscores the critical need to address the digital divide to ensure equitable healthcare access during the pandemic and beyond. This study highlights the urgent need for policymakers and healthcare providers to focus on addressing the digital divide to ensure equitable access to healthcare services. By doing so, it will be possible to ensure that vulnerable populations are not left behind during this critical time. The findings of our study have important implications for healthcare policy and practice and can guide future research in this area. This study provides valuable insights into the determinants of healthcare access during the pandemic, which can inform efforts to improve healthcare delivery and promote health equity

The North-South Digital Divide in Information and Communication Technologies Development: the Case for Spanish Regions

The "New Economy" is a concept that is associated with the growth of the US economy in the second half of the nineties, which were characterised by high growth in GDP. In attempt to find an explanation for these events, research to date cites the main determinant to be the marked rise in labour productivity that came about as a result of the impact of Information and Communication Technologies, particularly the Internet. The purpose of the present study is to examine the phenomenon that has arisen around this "new or digital economy" and the development of the Internet from the macro and microeconomic viewpoint and then show how the Spanish regions lag behind the rest of Europe in this respect. Firstly, we present international evidences of the positive impact of ICT in terms of labour and multifactorial productivity in national economies, industrial sectors and firms. These evidences are contrasted with some spanish studies. Secondly, we measure the importance of ICT in Europe. We base our method on a set of indicators, classified into three areas: infrastructure and size of sector, use of Internet and electronic commerce, and social and economic effects. We then examine the Spanish situation electronic commerce, and social and economic effects. We then examine the Spanish situation within the context of the rest of Europe, and discover a major north-south digital divide affecting certain areas, along with major interregional disparities. As far as Internet development is concerned, there are major regional differences. The paper points out the fact that Spain registers the highest standard deviation, in other words, the greatest regional differences, which, reflected in terms of different synthetic/composite indicators. This lag in progress contrasts with Spain's public policies aimed at promoting the Internet. Nevertheless, Internet development can provide the opportunity to close this gap within the EU. It may, however, increase discrepancies between the regions, by giving regions with higher per capita income an advantage in terms of productivity and competitiveness, unless a determined effort is made to implement actions aimed at developing the information society.

Partnering with Patients and Families to Improve Diagnostic Safety through the OurDX Tool: Effects of Race, Ethnicity, and Language Preference

BACKGROUND: Patients and families at risk for health disparities may also be at higher risk for diagnostic errors but less likely to report them. OBJECTIVES: This study aimed to explore differences in race, ethnicity, and language preference associated with patient and family contributions and concerns using an electronic previsit tool designed to engage patients and families in the diagnostic process (DxP). METHODS: Cross-sectional study of 5,731 patients and families presenting to three subspecialty clinics at an urban pediatric hospital May to December 2021 who completed a previsit tool, codeveloped and tested with patients and families. Prior to each visit, patients/families were invited to share visit priorities, recent histories, and potential diagnostic concerns. We used logistic regression to determine factors associated with patient-reported diagnostic concerns. We conducted chart review on a random subset of visits to review concerns and determine whether patient/family contributions were included in the visit note. RESULTS: Participants provided a similar mean number of contributions regardless of patient race, ethnicity, or language preference. Compared with patients self-identifying as White, those self-identifying as Black (odds ratio [OR]: 1.70; 95% confidence interval [CI]: [1.18, 2.43]) or other race (OR: 1.48; 95% CI: [1.08, 2.03]) were more likely to report a diagnostic concern. Participants who preferred a language other than English were more likely to report a diagnostic concern than English-preferring patients (OR: 2.53; 95% CI: [1.78, 3.59]. There were no significant differences in physician-verified diagnostic concerns or in integration of patient contributions into the note based on race, ethnicity, or language preference. CONCLUSION: Participants self-identifying as Black or other race, or those who prefer a language other than English were 1.5 to 2.5 times more likely than their counterparts to report potential diagnostic concerns when proactively asked to provide this information prior to a visit. Actively engaging patients and families in the DxP may uncover opportunities to reduce the risk of diagnostic errors and potential safety disparities

Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net.

ObjectivesDriven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP).Materials and methodsThe Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data.ResultsOf the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation.ConclusionsSafety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities

The Impact of Remote Patient Monitoring on Chronic-Disease Readmissions: The Role of Disparities

While prior research has found evidence of the digital divide in health IT outcomes, we do not know the combination of conditions under which health IT is more or less effective at reducing readmissions. This study examines the average and heterogeneous treatment effect of Remote Patient Monitoring (RPM) adoption on chronic-disease related readmissions. We first apply a deductive, econometric-driven approach (difference-in-differences) and then an inductive, machine learning-driven approach (casual forest). We find that RPM reduces the excess readmission ratio of pneumonia, heart failure, and chronic obstructive pulmonary disease. Furthermore, we find heterogeneity in the impact of RPM on heart failure readmissions based on the levels of patient complexity and local competition. Our research contributes to the literature on health IT digital divide by highlighting the combination of conditions in which RPM effectively reduces chronic-disease related readmissions. This combined research approach also contributes methodological insights to IS literature

Patient Engagement in Patient Portals in Appalachia Versus Surrounding US Census Regions: An Analysis of HINTS (Health Information National Trends Survey) Data, 2017 - 2020

OBJECTIVE: Those living in the Appalachian regions face more significant healthcare disparities than those in the US. Patient portals can decrease disparities and increase health outcomes and health literacy. The purpose of this study was to determine if those living in the Appalachian region were offered access to and used their patient portals differently than the surrounding US Census region. Additionally, we aimed to determine if there was a difference in reported reasons for non-use of patient portals. METHODS: This was a descriptive study using data from the National Cancer Institute’s Health Information National Trends Survey (HINTS) data (2017-2020) to determine if there is a difference in the use of patient portals in the Appalachian region compared to the surrounding US Census regions. RESULTS: There was no statistically significant difference between the Appalachian and surrounding US Census regions in being offered access to and the use of patient portals. However, when holding race constant, there was a statistically significant difference between regions in the use of patient portals for non-Hispanic whites (p = 0.0192). Common reasons for non-use of patient portals were preferred to speak directly to the provider and perceived CONCLUSIONS: Providers in the Appalachian region should be aware of the non-use of patient portals by non-Hispanic whites. Moreover, understanding the reported reasons for non-use may help providers tailor educational materials to increase the use of patient portals

Virtual Care and the Inverse Care Law: Implications for Policy, Practice, Research, Public and Patients.

Virtual care spread rapidly at the outbreak of the COVID-19 pandemic. Restricting in-person contact contributed to reducing the spread of infection and saved lives. However, the benefits of virtual care were not evenly distributed within and across social groups, and existing inequalities became exacerbated for those unable to fully access to, or benefit from virtual services. This "perspective" paper discusses the extent to which challenges in virtual care access and use in the context of COVID-19 follow the Inverse Care Law. The latter stipulates that the availability and quality of health care is inversely proportionate to the level of population health needs. We highlight the inequalities affecting some disadvantaged populations' access to, and use of public and private virtual care, and contrast this with a utopian vision of technology as the "solution to everything". In public and universal health systems, the Inverse Care Law may manifests itself in access issues, capacity, and/or lack of perceived benefit to use digital technologies, as well as in data poverty. For commercial "Direct-To-Consumer" services, all of the above may be encouraged via a consumerist (i.e., profit-oriented) approach, limited and episodic services, or the use of low direct cost platforms. With virtual care rapidly growing, we set out ways forward for policy, practice, and research to ensure virtual care benefits for everyone, which include: (1) pay more attention to "capabilities" supporting access and use of virtual care; (2) consider digital technologies as a basic human right that should be automatically taken into account, not only in health policies, but also in social policies; (3) take more seriously the impact of the digital economy on equity, notably through a greater state involvement in co-constructing "public health value" through innovation; and (4) reconsider the dominant digital innovation research paradigm to better recognize the contexts, factors, and conditions that influence access to and use of virtual care by different groups

Calling Doctor Google? Technology Adoption and Health Information Seeking among Low-income African American Older Adults

We conducted focus groups with low-income African American older adults in Kansas City, MO, to examine how this underserved group adopts and uses technology and how technology adoption/use is associated with health information seeking behavior. Low-income African American older adults have been shown to lag behind in terms of their technology access and use. Our findings show that although low-income African American older adults perceive technology to be highly useful, they do not view it as easy to use, thus preventing them from further adopting or using relevant technologies. Consequently, there is skepticism with respect to using technology to search for health information. Our study advances research on underserved groups’ technology use and health information seeking by looking at the intersectionality of race/ethnicity, age, and income