Doctoral Dissertations

Date of Award

5-2017

Degree Type

Dissertation

Degree Name

Doctor of Philosophy

Major

Nursing

Major Professor

Carole R. Myers

Committee Members

Donald E. Lighter, Sadie P. Hutson, Tami H. Wyatt

Abstract

Three in four Americans aged 65 and older is living with multiple chronic conditions. These patients have complex care needs and stand to benefit from tools facilitating engagement in their healthcare. Little is known regarding use of the electronic patient portal as a tool to support self-care in patients with multiple chronic conditions. The purpose of this multiple-methods study was to (1) explore characteristics and patterns of portal use by patients with multiple chronic conditions and (2) to understand the perceived usefulness of this tool to improve self-care. In phase 1, the quantitative phase, data from electronic health records and web server log files were analyzed. Patients (n=500) who were 45 years or older, registered portal users, and diagnosed with at least two chronic conditions were included in the analysis. No significant differences in portal use were found according to demographic characteristics, distance separating the patient from their primary care provider, and practice size and location. There was a significant difference between patients who accessed the portal to send a message to the provider and patient entered data in regards to logins (p< .001 and p=.03). In phase 2, the qualitative phase, semi-structured interviews with patients (n=9) and providers (n=7) were conducted to understand how patients learn about the portal and their perceptions of usefulness for improving self-care in patients with multiple chronic conditions. Twelve categories related to four broad themes: 1) how patients are introduced to the EPP, 2) perceived benefits of the EPP, 3) perceived barriers to using the EPP, and 4) perceptions of using EPP for self-management of chronic illness were revealed. Implications for further research, policy, and practice are presented.

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