Disparities in Activation and Use of Patient Portals Among Spanish-Speaking Patients

Objectives Patient portal use has steadily increased across most populations. Prior, now dated, studies indicated lower adoption rates among Spanish- vs. English- speaking patients. This study compared patient portal activation and use patterns between Spanish- and English-speaking patients. Methods This retrospective cohort study was conducted at three North Texas health systems using the MyChart patient portal (Epic Systems Co.) and included patients ≥18 years with ≥1 completed clinician encounter between 4/5/2021 and 4/4/2022. The primary activation outcome was the baseline MyChart account activation rate. The secondary activation outcome was the MyChart account activation rate within the following year among patients without an account at baseline. The primary use outcome was the rate of patients logging in. Secondary use outcomes included rates of results review, notes review, and message initiation in the following year. We also evaluated the rates of proxy account use and mobile app use. We fit multivariable logistic regression models adjusting for health system, age, sex, comorbidity count, and the number of prior-year encounters. Results Spanish speakers represented 128,338 of 1,550,220 (8.3%) patients. Spanish speakers had lower odds of having an activated account at baseline (aOR 0.39 [0.39 – 0.40]) or activating one in the next year (aOR 0.68 [0.65 – 0.71]). Spanish speakers also had lower odds of logging in (aOR 0.62 [0.61 – 0.63]), reviewing results (aOR 0.79 [0.76 – 0.81]), reviewing notes (aOR 0.87 [0.84 – 0.89]), or sending messages (aOR 0.41 [0.40 – 0.42]). More Spanish than English speakers used the mobile app (59% vs 50%). There were inter-site differences in the rate of proxy account use. Conclusions Given lower levels of portal activation and use among Spanish-speaking patients, strategies are needed to identify and address barriers to activation and use. Qualitative studies could delineate these barriers and potential mitigating strategies.