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Sociodemographic Differences in Patient Portal Adoption and Use among Veterans with Diabetes

Shimada SL, Allison JJ, Brandt CA, Rosen AK, Feng H, Rao S, Houston TK. Sociodemographic Differences in Patient Portal Adoption and Use among Veterans with Diabetes. Poster session presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.

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Research Objective: Patient portals and Personal Health Records (PHRs) can assist patients in managing their health. PHR use has been associated with increased overall patient satisfaction and has the potential to lead to improved health outcomes. Despite this promise, limited research to date has shown that racial/ethnic and socioeconomic differences in access to PHRs may prevent vulnerable populations from fully benefiting from PHRs. Our objective was to assess sociodemographic differences in access to and use of key features of the My HealtheVet (MHV) patient portal within a population of Veterans with diabetes. Study Design: This was a cross-sectional database study of My HealtheVet use and patient demographics utilizing 2009-2013 data from the Veterans Health Administration (VHA) Corporate Data Warehouse. We merged in zipcode-level data on educational attainment from the US Census Bureau's 2007-2011 American Community Survey. Population Studied: All VHA patients with a diagnosis of diabetes by April 2009 and at least two outpatient visits or one hospitalization per year between April 2009 and March 2012 (N = 887,132) were included in the analysis. Principal Findings: Among all Veterans with diabetes, 245,814 (27.7%) had registered for MHV access, and the remainder (72.3%) had not. Of these registrants, 150,718 (61.3%) had used the online prescription refill (Rx Refill) feature, 58,760 (23.9%) had used the patient-provider Secure Messaging (SM ) feature, 50,549 (20.6%) were 'super users' who had used both SM and Rx Refills, and 86,885(35.4%) had never used either feature as of April 2013. There were differences in the socio-demographic composition of these use categories. Younger age, female gender, urban residence, and residence in areas with higher educational attainment were positively associated with use of both Rx Refill and SM. Qualifying for free VA care based on income and being African-American or Latino was negatively associated with both adoption and use of the MHV portal. Among the non-registered, 64.8% were White, 16.7% were African-American, and 6.1% were Latino, whereas among the 'super users' using both Rx Refill and SM, 75.2% were White, 10.7% were African-American, and 3.6 % were Latino. The non-registered were 2.2% female, had an average age of 71.3years, and 29.2% qualified for free VA care based on income. 'Super users' were 5.3% female, had a mean age of 63.7 years, and only 17.2% qualified for free care. Conclusions: Although the MHV portal is available to all Veterans, there are racial/ethnic, gender, geographic, and socioeconomic differences in adoption and use of the portal. Veterans in vulnerable groups may be less likely to reap the benefits of PHR-based interventions because of differences in adoption and use. Implications for Policy, Delivery, or Practice: Strategies to support vulnerable populations are needed to ensure that health disparities do not widen as healthcare systems implement new technologies to increase access and improve outcomes.

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