Patient- and Provider-Level Factors Associated with Patient Portal Usage Among Medicaid Recipients.

Patient portals can improve access to electronic health information and enhance patient engagement. However, disparities in patient portal utilization remain, affecting disadvantaged communities disproportionately. This study examined patient- and provider-level factors associated with portal usage among Medicaid recipients in a large federally qualified health center (FQHC) network in Texas. Deidentified electronic medical records of patients 18 years or older from a large Texas FQHC network were analyzed. The dependent variable was a binary flag indicating portal usage during the study period. Independent variables included patient- and provider-level factors. Patient-level factors included sociodemographic, geographic, and clinical characteristics. Provider characteristics included primary service line, provider type, provider language, and years in practice. Because the analysis was at the individual level, a multivariable logistic regression model focused on adjusted associations between independent variables and portal usage. The analytic sample consisted of 9,271 individuals. Compared with individuals 18-39 years, patients 50 years and older had lower odds (50-64 OR: 0.60, < 0.001; 65+ OR: 0.51, < 0.001) of portal usage. Males were less likely to use portals (OR: 0.44, = 0.03), and compared to Non-Hispanic Whites, Non-Hispanic Black (OR: 0.86, = 0.02) and Hispanics (OR: 0.83, < 0.001) were significantly less likely to use portals. Individuals with 1 or more telemedicine consults had a two-times greater odds of portal usage (OR: 1.97, < 0.001). Compared to individuals who had clinic visits in December 2018, portal usage was significantly higher in the pandemic months (March 2020-November 2020, all 's < 0.01). Importantly, the behavioral health service line had the greatest odds (OR: 1.52, < 0.001), whereas the dental service line had the lowest odds (OR: 0.69, = 0.01) compared to family practice. No other provider characteristics were significant. Our finding of significant patient-level factors is important and can contribute to developing appropriate patient-focused health information technology approaches to ensure equitable access and maximize the potential benefits of patient portals in health care delivery.