Social Disparities in Internet Patient Portal Use in Diabetes: Evidence that the Digital Divide Extends Beyond Access
A recent study published in the Journal of the American Medical Informatics Association examined differences in utilization of information technology among diabetic patients in Northern California, and found that African Americans, Latinos, and people with lower levels of education were less likely to use the internet-based patient portal to access medical care services than non-Hispanic Caucasians or persons with a higher level of education.
Using data from the Kaiser Permanente Northern California (KPNC) Diabetes Registry, researchers identified obtained survey responses for 20,188 patients about their usage of members-only web portal, and included data from 14,102 patients who reported speaking and reading English, had adequate vision, and had been enrolled in KPNC for all of 2006. Respondents were tracked to determine whether they requested a password, activated their accounts, logged on, and completed the log on step that would allow them to view lab results, email their provider, make appointments, and request medication refills. The authors found differences in utilization among racial and ethnic groups and among individuals with different levels of educational attainment. Compared to 51% of non-Hispanic whites, only 31% of African-Americans and 21% of Latinos requested a password (p < 0.01). Similar differences were found when the authors analyzed educational attainment and web portal usage. Compared to those with a college degree, patients with lower levels of educational attainment had a greater odds of never logging on. Use of individual web functions (e.g. viewing lab results, emails, appointments, etc.) also differed by race and ethnicity and educational attainment, such that individuals with lower educational attainment and racial and ethnic minorities were less likely to use the web functions than non-Hispanic whites and individuals with higher educational attainment.
The authors offered several theories to explain the observed differences and underscored the internet's potential to enhance comprehensibility of health care and health promotion. They noted that "barriers to internet-based healthcare services require attention to disadvantaged groups and tailoring services as well as expanded computer/internet access."
- (Sarkar U, Karter AJ, et. al. "Social Disparities in Internet Patient Portal Use in Diabetes: Evidence that the Digital Divide Extends Beyond Access." Journal of the American Medical Informatics Association, (January 24, 2011) doi: 10.1136/jamia.2010.006015).http://jamia.bmj.com/content/early/2011/01/24/jamia.2010.006015.abstract
In 2009, Congress passed the Patient Protection and Affordable Care Act (ACA) that was signed into law by President Obama on March 23, 2010 (Pub.L.No.111-148) containing several provisions aimed at reducing health disparities. The new set of laws aims at reducing healthcare cost and increase health coverage. This is a summary of some of the provisions to improve the health of racial and ethnic diverse populations.
The ACA includes provisions on data collection and reporting to workforce diversity to health disparities research. Some examples of these include monitoring of health disparities trends in federally-funded programs (Section 4302); conduct population surveys and collect and report data on race, ethnicity and primary language; providing grants for Community Health Workers; providing culturally and linguistically appropriate services (CLAS) (Section 5313) and creating a curricula for culture competence education (Section 5307).
Some general provisions with significant implications for racially and ethnically diverse populations include:
- Individual requirement to have coverage
- Expanding Medicaid income eligibility to 133 percent of the Federal poverty line
- Small business (less than 25 employees) tax credits
- Increase Federal matching rates for Medicaid
- Consumer Operated and Oriented Plan (CO-OP)
With regard to the small business tax credits, ACA requires employees to offer coverage to the employee or pay a penalty for any full-time employee who receives a premium tax credit for purchasing their own coverage. Small businesses with less than 25 employees will get a tax credit of up to 50 percent (in 2014) of employer's contribution toward employee health insurance. This is especially important given that over 90 percent of minority-owned firms have fewer than 25 employees, and diverse populations are more likely to be employed by a small firm that currently does not have coverage . In fact, 57 percent of Hispanics/Latinos, 40 percent of African Americans, 40 percent of American Indians/Alaska Natives and 36 percent of Asian Pacific Islanders are uninsured, compared to 24 percent of Whites .
In 2014, ACA will provide immediate assistance to individuals with pre-existing conditions who have been uninsured for at least 6 months by creating state-sponsored high-risk insurance pools and providing subsidized premiums. By removing the coverage barrier, Americans will benefit with increased access to service.
A special article on how ACA is addressing health disparities can be found at http://www.healthcare.gov/law/infocus/disparities/index.html. Information on health care reform can be found at http://www.healthcare.gov.
- Lowrey, Y. (2007). Minorities in Business: A demographic review of minority business ownership. Small Business Administration. Source: http://www.sba.gov/advo/research/rs298tot.pdf.
- Kaiser Family Foundation. (2009). Health Reform and Communities of Color: How might affect racial and ethnic health disparities? Facts on Health Reform.
Jun 1, 2011
(HealthNewsDigest.com) - States are seeing improvements in health care quality, but disparities for their minority and low- income residents persist, according to the 2010 State Snapshots, released today by the Agency for Healthcare Research and Quality.
New Hampshire, Minnesota, Maine, Massachusetts and Rhode Island showed the greatest overall performance improvement in 2010. The five states with the smallest overall performance improvement were Kentucky, Louisiana, New Mexico, Oklahoma and Texas. As in previous years, AHRQ's 2010 State Snapshots show that no state does well or poorly on all quality measures.
Among minority and low-income Americans, the level of health care quality and access to services remained unfavorable. The size of disparities related to race and income varied widely across the states.
"Every American should have access to high-quality, appropriate and safe health care, and we need to increase our efforts to achieve that goal because our slow progress is not acceptable," said AHRQ Director Carolyn M. Clancy, M.D. "These AHRQ 2010 State Snapshots not only provide states with a benchmark on how they are doing in these areas, but they also provide resources that states can use to make improvements."
The 2010 State Snapshots, an interactive Web-based tool, show whether a state has improved or worsened on specific health care quality measures. For each state and the District of Columbia, this tool features an individual performance summary of more than 100 measures, such as preventing pressure sores, screening for diabetes-related foot problems and giving recommended care to pneumonia patients. It also compares each state to others in its region and the nation.
Easy-to-read data charts indicate current strengths, weaknesses and opportunities for improvement for each state. Health leaders, insurers, providers, researchers and consumers can use the State Snapshots data to examine the extent of health care quality and disparities in their states and take steps to address gaps in quality care and access to services.
The 2010 State Snapshots summarize health care data by:
- Overall health care quality;
- Type of care (preventive, acute and chronic);
- Treatment setting (hospital, ambulatory care, nursing home and home health) ;
- Five clinical conditions (cancer, diabetes, heart disease, maternal and child health and respiratory diseases); and
- Strongest and weakest quality measures, as compared with other states.
A new feature this year is a State Resource Directory that provides tools and information on assessing quality measures and disparities data that states can use to develop their own health care quality and disparities measures. Also available are direct links to AHRQ's Health Care Innovations Exchange, a searchable database in which users can find information and resources on evidence-based innovations that others in their states have used to improve care.
Other highlights include special focus areas on diabetes, asthma, clinical preventive services, disparities, health coverage status and variations over time.
The 2010 State Snapshots are based on data from the 2010 National Healthcare Quality Report and National Healthcare Disparities Report, which are mandated by Congress and produced annually by AHRQ. Data are drawn from more than 30 sources, including government surveys, health care facilities and health care organizations.
To see the 2010 State Snapshots, go to http://statesnapshots.ahrq.gov
- From HealthNewsDigest.com