Identifying Factors Associated With Patient Portal and Synchronous Telehealth Use Across Age Groups in the Postpandemic Era: Retrospective Analysis of the Health Information National Trends Survey

TL;DR

This study explores how different age groups use patient portals and telehealth services after the pandemic, finding that older adults show unique patterns influenced by factors like care frequency and race.

Contribution

The study identifies age-specific factors influencing patient portal use among older adults, which differ from synchronous telehealth adoption.

Findings

Older adults with higher care frequency are less likely to use patient portals.

Older adults who complete surveys online are more likely to use patient portals.

Older Black or African American patients are less likely to use patient portals.

Abstract

Since the COVID-19 pandemic, telehealth has become a core component of modern health care, encompassing both synchronous services (real-time video or phone) and patient portals, which offer a wide range of online features to streamline care delivery, including asynchronous communication and access to medical records. Older adults often face greater barriers to these technologies, potentially widening health care access gaps.

This study examines factors influencing the adoption of patient portals and synchronous telehealth in the postpandemic era. It compares the 2 modalities and identifies distinct usage patterns across age groups to inform targeted strategies.

We analyzed data from the Health Information National Trends Survey (HINTS) Cycles 6 and 7. Outcomes over the past 12 months included (1) frequency of patient portal use (continuous), (2) use of synchronous telehealth (binary), and (3) no engagement with any telehealth services (binary). Key variables included demographics, socioeconomic status, technology familiarity, and health care behaviors. Age groups were categorized as young (18–49 years), middle-aged (50–64 years), and older adults (≥65 years). Interaction terms between age groups and other variables were included to uncover age-specific patterns. To mitigate multicollinearity arising from the interaction terms, we used penalized linear and logistic regression models using the least absolute shrinkage and selection operator (LASSO) penalty without survey weights, supplemented by bootstrapping to evaluate the stability. Using the selected variables, we then fitted survey-weighted generalized linear models to account for the complex design of the HINTS survey and more accurately represent the US population.

Among 12,865 respondents, 36.1% (n=4638) were 65 years or older. Overall, 65.2% used patient portals and 38.4% used synchronous telehealth. Age alone was not a significant factor, but older adults exhibited distinct patterns. Older adults with higher care frequency were less likely to use patient portals (coefficient −0.07, 95% CI −0.10 to −0.04; P<.001). Those who completed the survey online in this age group were more likely to use patient portals (coefficient 0.32, 95% CI 0.18-0.47; P<.001) than to use a paper form. Older Black or African American patients were less likely to use patient portals (coefficient −0.30, 95% CI −0.45 to −0.16; P<.001). These age-specific patterns were identified only in patient portal use, not in synchronous telehealth use.

Telehealth usage among older adults differs in subtle ways from other age groups, and the factors driving adoption vary between patient portals and synchronous care. These findings underscore the need for age- and context-specific strategies to enhance the uptake of both types of services.

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