An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis
Authors: Chivela Fernando L , Burch Ashley E , Asagbra Oghale 
Published: May 2023

Background
Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited.

Objective
This study aimed to explore the factors associated with portal messaging use by rural patients.

Methods
We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient’s number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient’s home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density.

Results
A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income.

Conclusions
Patients’ use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.