# Users’ perspectives on a demonstration to increase shared access to older adults’ patient portals

## TL;DR

This study explores how a shared access initiative for older adults' patient portals was perceived by users and identifies factors that helped or hindered its adoption.

## Contribution

The paper introduces a user-centered evaluation of a shared access initiative for patient portals, highlighting practical implementation strategies and barriers.

## Key findings

- The shared access initiative was seen as appropriate, useful, and well-received by patients and care partners.
- Barriers included clinicians' competing priorities and low awareness among patients and care partners.
- Facilitators included alignment with clinic practices and organizational policies.

## Abstract

Many patient portals allow patients to authorize a care partner to use the portal on their behalf, with evidence suggesting a range of benefits to patients, care partners, and clinicians. Shared or proxy access aligns with patient- and family-centered care and supports care partners’ legitimacy and identification by clinicians in patient portal interactions. As shared access uptake remains low, the Coalition for Care Partners (https://coalitionforcarepartners.org) and three healthcare delivery organizations co-designed an initiative promoting shared access to the patient portals of older adults.

To evaluate an initiative’s demonstration through users’ perspectives.

The 12-month demonstration was launched at five clinics (geriatric oncology, primary care, and geriatric medicine) across the three organizations. Clinicians and staff were interviewed mid- and post-demonstration via focus groups and individually; clinic patients and care partners responded to an anonymous post-demonstration online portal survey.

Demonstration users included established patients from the five clinics and their care partners, as well as clinic physicians, nurses, social workers, care managers, patient-facing staff, administrators, and information technology specialists.

We followed the Consolidated Framework for Implementation Research to develop interview guides and inform our analysis of the survey’s open-ended responses and interview transcripts. We analyzed 11 focus groups, 10 individual interviews, and 392 patients’ and 79 care partners’ survey responses employing rapid assessment procedures methodology.

The demonstration was appropriate, useful, routinized in the clinics, and well received by patients and care partners. The demonstration was perceived as undemanding and low-cost, utilizing existing infrastructure and organizational processes. Facilitators included alignments of shared access with clinics’ practice and philosophy, organizations’ policies, and needs of patients and care partners. Identified barriers included clinicians’ competing priorities and patients’ and care partners’ low awareness and motivation for using shared access.

The Coalition for Care Partners can spread this appropriate, useful, undemanding, and low-cost initiative. Further efforts might be supported by policies that ensure that shared access benefits are bolstered, potential harms of unidentifiable access are emphasized, and registration is conceptualized as an opt-out versus opt-in process.

The online version contains supplementary material available at 10.1186/s12913-025-12755-0.