Background/Purpose: Many aspects of rheumatic and musculoskeletal disease (RMD) management require a high level of patient agency and open avenues for patient-provider contact. In the era of COVID-19 and social distancing the shift to virtual care has become essential for the continued care of our patients. More so than ever before, patient portal and health technology use has become crucial in the care of patients with RMDs around the country.

Many studies have shown positive effects on outcomes and satisfaction when patients are more engaged in their care through digital technology use. However, several studies have shown that low health literacy, lower educational attainment, residence in a rural area, being of minority race/ethnicity, and older age are associated with lower rates of technology ownership and use.

To date there have been limited studies examining inequities in health technology use among patients with RMDs. Our goal is to identify characteristics of technology users versus non-users from a group of patients in a large hospital-based rheumatology clinic.

Methods: Epic (electronic medical record, EMR) data was queried to identify established patients of the University of North Carolina Hospitals adult rheumatology clinic between November 1, 2017 through November 30, 2019. Demographic and clinical data were collected and used to compare patients who have activated Epic’s patient portal (MyChart) to patients who have not activated MyChart. MyChart use was modeled using logistic regression and adjusted odds ratios and confidence intervals were estimated.

Results: We identified 5287 established patients who were seen at our clinic during the study period. The mean age was 54.4 years and 73.6% were female. Fifty-one percent of established patients identified as white/Caucasian and 26.6% as black/African American. Eighty-nine percent identified English as their primary language. Patients were evenly split between urban, suburban, and rural residences. Two-thirds had a median adjusted gross income between $25,000 – < $50,000. Thirty-six percent had Medicare and 25.4% had commercial insurance.

Using data from complete cases among North Carolina residents (n=4756), we found that younger age, suburban residence, commercial/state/military insurance, and median income $50,000 or greater were associated with significantly higher odds of MyChart activation.

Characteristics significantly associated with lower odds of MyChart use were male gender, black/African American or “other” race, Spanish as primary language, rural residence, Medicaid as primary payor, and median annual income < $25,000.

Conclusion: These results support the findings of previous studies that show that residence in a rural area, being of minority race/ethnicity, and older age are associated with lower rates of health technology use. We also noted that lower median income, having Medicaid as primary insurance, and non-English primary language are associated with lower odds of patient portal activation. We hope that by studying factors associated with lower EMR use we can identify at-risk populations who may benefit from targeted interventions to close the gap in health technology use among patients with RMDs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disparities-in-patient-portal-use-among-patients-with-rheumatic-and-musculoskeletal-diseases-in-a-large-academic-medical-center/