Do online patient portal access disparities persist in the urogynecology population

Objective: The COVID-19 pandemic has necessitated increased utilization of telemedicine and virtual healthcare, thereby highlighting the importance of patient access to electronic patient portals. Disparities in patient portal access and utilization have been linked to race, gender, age, and geography amongst other factors. The objective of this study was to assess for variables associated with patient portal access, with a particular focus on the Urogynecology population. Methods: We describe a retrospective analysis of the first six years of patient portal activation, from 2011-2016, within a large academic medical center. The primary endpoint was activation of the online patient portal. Data including demographics, diagnosis codes, and patient portal activation status was extracted from the Obstetrics and Gynecology (Ob/Gyn) clinic and subspecialty clinics, as well as the Family Medicine (FM) clinic. Patients could be coenrolled in separate clinics. Zip codes were used to approximatemedian income and urban/suburban/rural designation from the Census and USDA respectively. Disease burden was calculated by the sum of organ systems with an associated diagnosis code. Chi square and binomial regression models were used to calculate the odds ratios of the various factors in predicting patient portal activation. Results: The total population included 88,511 patients (Ob/Gyn n = 42,693, FM n = 45,479, Urogynecology n = 1,593). By 2016, 40.1% of all patients had activated their patient portal. Black race was associated with lower odds of patient portal activation (aOR 0.67, 95% CI 0.63-0.71). This difference did not persist in the younger population and was apparent after age 40 (see Figure 1). Other significant factors that lead to decreased odds of patient portal usage were suburban/rural zip code, and non-private insurance. Larger disease burden (aOR 1.24, 95% CI 1.22-1.25) was associated with increased odds. With the exception of Urogynecology, treatment by any other Ob/Gyn subspecialty clinic led to increased odds of portal activation. When Urogynecology was analyzed separately, Black race (aOR 0.48, 95% CI 0.24-0.93), larger disease burden (aOR 1.23, 95% CI 1.163-1.307), and treatment by the Gynecology Oncology department (aOR 6.64, 95% CI 1.25-35.37) remained significant. Conclusions: Similar to findings of previous research, our model highlights disparities in electronic patient portal access, which persist in the Urogynecology population. While race did appear to influence portal usage, it did so only after the age of 40, suggesting a generational influence. Patient portal utilization was lower in the Urogynecology department compared to other divisions with similar demographics, like Gynecology Oncology, suggesting room for improvement and the need for additional attention.