Differences in Use of a Patient Portal Across Sociodemographic Groups: Observational Study of the NHS App in England
Authors: KC Sukriti , Papoutsi Chrysanthi , Reidy Claire , Gudgin Bernard , Powell John , Majeed Azeem , Greaves Felix , Laverty Anthony A 
Published: August 2024

Background
The adoption of patient portals, such as the National Health Service (NHS) App in England, may improve patient engagement in health care. However, concerns remain regarding differences across sociodemographic groups in the uptake and use of various patient portal features, which have not been fully explored. Understanding the use of various functions across diverse populations is essential to ensure any benefits are equally distributed across the population.

Objective
This study aims to explore differences in the use of NHS App features across age, sex, deprivation, ethnicity, long-term health care needs, and general practice (GP) size categories.

Methods
We used weekly NHS App use data from the NHS App dashboard for 6386 GPs in England from March 2020 to June 2022. Negative binomial regression models explored variations in weekly rates of NHS App features used (registrations, log-ins, prescriptions ordered, medical record views, and appointments booked). Outcomes were measured as weekly rates per 1000 GP-registered patients, and we conducted separate models for each outcome. Regression models included all covariates mentioned above and produced incident rate ratios, which we present here as relative percentages for ease of interpretation. GP-level covariate data on sociodemographic variables were used as categorical variables in 5 groups for deprivation (Q1=least deprived practices and Q5=most deprived practices) and 4 groups for all other variables (Q1=least deprived practices and Q4=most deprived practices).

Results
We found variations in the use of different features overall and across sociodemographic categories. Fully adjusted regression models found lower use of features overall in more deprived practices (eg, Q5 vs Q1: registrations=–34%, log-ins=–34.9%, appointments booked=–39.7%, medical record views=–32.3%, and prescriptions ordered=–9.9%; P<.001). Practices with greater proportions of male patients also had lower levels of NHS App use (eg, Q4 vs Q1: registration=–7.1%, log-in=–10.4%, and appointments booked=–36.4%; P<.001). Larger practices had an overall higher use of some NHS App features (eg, Q4 vs Q1: registration=3.2%, log-ins=11.7%, appointments booked=73.4%, medical record views=23.9%, and prescriptions ordered=20.7%; P<.001), as well as those with greater proportions of White patients (eg, Q4 vs Q1: registration=1.9%, log-ins=9.1%, appointments booked=14.1%, medical record views=28.7%, and prescriptions ordered=130.4%; P<.001). Use patterns varied for practices with greater proportions of patients with long-term health care needs (eg, Q4 vs Q1: registrations=–3.6%, appointments booked=–20%, and medical record views=6%; P≤.001).

Conclusions
This study highlights that the use of the NHS App features varied across sociodemographic groups. In particular, it is used less by people living in more deprived areas. Tailored interventions and patient support are required to ensure that any benefits from the NHS App are spread equally throughout the population.