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What Patient Demographics Use Patient Portal Appointment Scheduling?

Those using the patient portal for online appointment scheduling skew younger and Whiter, leading experts to be concerned about care access equity.

Young, White patients with commercial health payer coverage are more likely to use the patient portal for online appointment scheduling than others, according to the latest data in JAMA Network Open.

Patients using the patient portal for online appointment scheduling, otherwise known as direct scheduling, were also more likely to have a least one comorbidity and to have a history using the technology before the study period.

Direct scheduling based in the patient portal has long been viewed as a strategy to improve patient access to care in a convenient way. The technology is available 24 hours per day, and lets patients bypass a call center that could tie them up for a prolonged period.

“This offering may have additional benefits, especially in the primary care setting, such as promoting continuity with one’s usual primary care physician (PCP),” the researchers said. “Conversely, direct scheduling might worsen disparities in access to care via the so-called digital divide.”

In a cross-sectional study of slightly over 62,000 patients at 17 primary care sites, the researchers observed patterns that could substantiate their hypothesis. The data, which was collected between March 2018 through March 2019 among patient portal adopters, showed a direct scheduling user base that was largely White, young, and commercially insured.

Of the 5,531 patients who used the patient portal for appointment scheduling, 1,979 used the tool to book general wellness checks. Another 5,267 patients used the technology to book with their own provider.

By and large, practices that had offered direct scheduling capabilities to patients for a long time prior to the study period saw broader and more diverse adoption.

These findings have both positive and negative implications, the researchers said. Notably, online appointment scheduling did show some evidence of improving care coordination.

“Our results suggest that direct scheduling may contribute to continuity and access, core aspects of high-functioning primary care that are associated with better health outcomes and lower costs,” the researchers reported.

The data showed that patients using direct scheduling were more likely to obtain an appointment with their own primary care provider, even if the appointment was not for a wellness exam, than those using telephonic scheduling. This could potentially be explained by most patient portals requiring patients to schedule an appointment with a provider they have already met.

Direct scheduling also displayed some other benefits, including being perceived as more convenient for patients. Patients largely used the patient portal to schedule appointments during traditional business hours. These patients could have called the office, the researchers theorized, and yet the online scheduling option was still more attractive.

Those benefits notwithstanding, the demographics of usual direct scheduling adopters rang alarm bells for the researchers. Currently, the digital technology is going down a path that could deepen health disparities.

The widespread adoption of online appointment scheduling among White, young, and commercially insured users could crowd out appointment slots for individuals not using the technology — older patients that are part of traditionally marginalized groups and who need greater access to care.

These concerns are further exacerbated when considering the study sample, the researchers added. The current research only included individuals who had already signed up for the patient portal, a population that largely skews White, young, and affluent.

The team did acknowledge some concerns that direct scheduling via the patient portal could result in a higher number of unnecessary office visits. Although study results indicated that most of the directly scheduled appointments were for lower-acuity care, the team also pointed out that direct scheduling users had vastly more comorbidities and thus may have still needed that care.

In the future, it may be beneficial for research to look into how direct scheduling via the patient portal helps practice operations and efficiency. Although the current study authors did not broach this territory, they did suggest there is some promise here.

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