Use of Electronic Patient Messaging by Pregnant Patients Receiving Prenatal Care at an Academic Health System (Preprint)

Abstract

Use of electronic medical record (EMR) patient portal messaging has rarely been studied in maternity care.

This study aimed to estimate changes in patient portal use and intensity in prenatal care before and during the pandemic period.

In this study, patients seen for prenatal care at a large academic medical center were categorized by the number of secure messages sent during pregnancy as non-users, infrequent (5), moderate (6-14), or frequent (15). Monthly portal use intensity rates were computed over 43 months from 2018-2021 before to after the COVID pandemic shutdown. A logistic regression model was estimated to identify patient sociodemographic and clinical subgroups with the highest portal non-use.

Among 12,380 patients, 21.7% never used the portal, and 21.6%, 30.3%, and 26.4% were infrequent, moderate, and frequent users, respectively. Portal use and intensity increased significantly over the study period, particularly after the pandemic. However, non-Hispanic Black, Hispanic, non-English-speaking, and Medicaid-insured patients continued to have significantly lower likelihoods of portal use. Patients with pre-existing comorbidities, hypertensive disorders of pregnancy, diabetes, and a history of mental health conditions were all significantly associated with higher portal use and intensity.

Reducing disparities in messaging use will require outreach and assistance to low use patient groups, including education addressing health literacy and encouraging appropriate and effective use of messaging.