Improving Outpatient Safety of Older Adults Through Electronic Patient Portals

There are an estimated 46 million caregivers nationally, with 83 percent providing care for relatives. Caregivers are frequently responsible for tasks such as medication reminders, prescription refills, scheduling physician appointments, and communicating updates with the healthcare team. Electronic patient portals (EPPs) allow patients and caregivers to engage in care and send secure messages to providers, review test results, and refill medications. However, the training and support that caregivers receive to use EPPs is limited.

This project evaluated the impact of outpatient medication safety and communication between caregivers and healthcare providers when caregivers were given proxy access to EPPs. Study participants included older adult patients receiving care at the Northwestern Medicine internal medicine and geriatrics clinic, and their caregivers.

The specific aims of the project were as follows:

• Investigate whether EPP usage by caregivers facilitates the accuracy of outpatient medication reconciliation and healthcare provider communication. 
• Identify caregiver and older adult patient characteristics that correlate with usage and non-usage of EPP. 
• Determine barriers to EPP usage among caregivers of older adults and potential means of improving the accessibility and usability of EPPs. 
• Explore the content of EPP messages from caregivers of older adults to providers in order identify what the EPP is most being used for. 

Patients were enrolled in the EPP and provided consent to allow caregivers proxy access; both were shown how to use the tool. At baseline, 2 weeks, and 4 months, patient-caregiver pairs were interviewed to collect information on EPP use and self-reported data including cognitive function and health literacy assessments. Patient comorbidity, medication, and patient-caregiver communication history were extracted from the patient’s health record. Finally, a retrospective chart review was conducted to review patient-physician communication history data.

Researchers found that EPP access increased information exchange between caregivers and providers at 2 weeks; no changes in communication were seen at 4 months. Patients and caregivers used the EPP to message providers primarily regarding clinical questions about medications, influenza vaccinations, scheduling, and medication refills. Very few differences were observed between the types of messages sent by caregivers and patients. Reported barriers to EPP use included password issues, being too busy, not receiving prompt responses from providers, and difficulty reading the small print on the EPP messages. Investigators concluded that further research with a larger sample size is needed to investigate whether granting caregivers EPP usage facilitates the accuracy of outpatient medication reconciliation.