Use of patient portal messaging exploded during the COVID-19 pandemic, with steep increases in messages and phone calls between office visits. Patients have grown to enjoy the convenience of patient portal communications, using it mostly to contact medical staff and to receive answers to their questions.
However, convenience for the patient often comes with exhaustion and eventual burnout for the doctor and medical staff who not only meet with patients in the clinic, but answer patient portal questions as well.
For the first time, researchers from the Department of Family Medicine at the University of Michigan looked at why patients use portals as means of communication with their primary care doctors. Results were recently published in the paper, “Patient-reported reasons for sending portal messages: A survey of use in a family medicine department” in the Journal of General Internal Medicine. First author is Associate Professor Katherine J. Gold, MD, MSW, MS. Co-authors include Dongru Chen, MS; Gregory Shumer, MD, MHSA; Devon Kinney, MSQM; Lauren Marshall, MPH, MPP; Ananda Sen, Ph.D.; and Michael S. Klinkman, MD.
The researchers surveyed more than 50,000 patients in 2021 who had visited one of the department’s six clinics in the last 18 months, 4,795 of whom agreed to take future online surveys. A follow-up survey, distributed in English, Spanish and Japanese was conducted between October 2022 and January 2023.
Questions explored quality-of-life issues. The team also developed eight additional yes/no questions specifically about portal use.
From the follow-up survey, researchers examined 2,297 surveys, with mostly white females around the average age of 59 responding. Respondents were also mostly non-Hispanic, well-educated, and more than 60% held private health insurance.
- Nearly half (45%) endorsed using the portal to get health advice because they preferred it over an appointment; to reach the PCP when they couldn’t get an appointment (51%); to avoid using what they perceived as an inefficient phone system (45%); or to get a second opinion from their primary care doctors (15%).
- Of the 2,297 patients surveyed, 2,137 agreed the portal was an important part of their primary care experience. Younger patients showed higher agreement, with agreement only slightly decreasing with age.
- Eighty percent of patients agreed that the portal kept them better connected to their primary care doctor.
- Of 2,128 patients who selected one or more uses, the majority (78%) reported using the portal to get in touch with someone who could answer their questions or reach a clinician to address health problems (66%).
While patients derive benefits from telehealth, particularly those with multiple chronic conditions and those who are rural and without easy access to care, Gold et al say that the burden to medical staff and use of the portal to avoid inefficient scheduling and phone systems can lead to a worsening risk for burnout – a phenomenon already in play with having to manage patients’ electronic health records. This is especially so for clinics without adequate staff to handle portal requests.
“Future research should explore unintended consequences of increased portal messaging, patient preferences for how they receive care, and the impact of institutional billing for care through the portal on both message volume and health equity,” the authors wrote. “If unreimbursed portal care replaces office visits in a fee-for-service model, this has substantial impacts on the ability to finance primary care.”
Article citation: Gold, K. J., Chen, D., Shumer, G., Kinney, D., Marshall, L., Sen, A., & Klinkman, M. S. (2024). Patient-reported reasons for sending portal messages: A survey of use in a family medicine department. Journal of General Internal Medicine. https://doi.org/10.1007/s11606-024-08815-6
