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Social Determinants of Health Associated With Patient Portal Use in Pediatric Diabetes

Published:April 11, 2022DOI:https://doi.org/10.1016/j.jcjd.2022.04.002

      Abstract

      Objectives

      Social determinants of health (SDOH) are associated with type 1 diabetes (T1D) outcomes. Patient portal (PP) use can improve care quality. Therefore, equitable PP access is essential. Associations between SDOH and PP access have not been reported in pediatric T1D. The purpose of this study was to determine whether PP access and use are associated with SDOH in pediatric T1D.

      Methods

      This work was a cross-sectional study of patients <18 years of age with T1D who were seen in a diabetes clinic at a tertiary care centre between April 1, 2020, and March 31, 2021. Patient postal code, PP activation status and use, and characteristics were collected from electronic health records on April 1, 2021. SDOH were assessed using patient postal code linked to the Ontario Marginalization Index (ON-Marg) to determine quintile score across 4 dimensions of deprivation. Statistical analysis tested for an association between PP activation status and ON-Marg quintile.

      Results

      Data were obtained for 634 patients with a mean age of 12.8±3.8 years; 53% were male and mean glycated hemoglobin was 8.4±2.0%. In the last year, 334 patients (53%) were PP active and 332 (52%) used the PP. The odds of inactive PP status were higher for those with the highest degree of material deprivation (odds ratio [OR], 2.91; 95% confidence interval [CI], 1.62 to 5.36) and residential instability (OR, 3.49; 95% CI, 1.86 to 6.70). PP activation status was not associated with dependency or ethnic concentration.

      Conclusions

      In our pediatric T1D population, inactive PP status is associated with greater material deprivation and residential instability. How these factors impact PP activation and how to improve equitable access requires further study.

      Résumé

      Objectifs

      Les déterminants sociaux de santé (DSS) sont associés aux issues du diabète de type 1 (DT1). L’utilisation du portail des patients (PP) peut contribuer à l’amélioration de la qualité des soins. Toutefois, un accès équitable au PP est essentiel. Aucune association entre les DSS et l’accès au PP n’a été signalée chez les enfants et les adolescents atteints du DT1. L’objectif de la présente étude était de déterminer si l’accès et l’utilisation du PP sont associés aux DSS chez les enfants et les adolescents atteints du DT1.

      Méthodes

      Ces travaux constituaient une étude transversale auprès de patients < 18 ans atteints du DT1 qui avaient été vus à la clinique de diabète d’un établissement de soins tertiaires entre le 1er avril 2020 et le 31 mars 2021. Le 1er avril 2021, nous avons collecté dans les dossiers médicaux électroniques le code postal des patients, l’état d’activation, l’utilisation et les caractéristiques du PP. Nous avons évalué les DSS au moyen des codes postaux des patients liés à l’indice de marginalisation ontarien (ON-Marg) pour déterminer le quintile dans les 4 dimensions de privation. L’analyse statistique a permis de tester l’association entre l’état d’activation sur le PP et le quintile ON-Marg.

      Résultats

      Nous avons obtenu les données de 634 patients dont l’âge moyen était de 12,8 ± 3,8 ans; 53 % étaient des garçons, et l’hémoglobine glyquée moyenne était de 8,4 ± 2,0 %. Dans la dernière année, 334 patients (53 %) étaient actifs sur le PP et 332 (52 %) utilisaient le PP. La probabilité d’un état inactif sur le PP était plus élevée chez les patients qui avaient un plus haut degré de privation matérielle (rapport de cotes [RC], 2,91; intervalle de confiance [IC] à 95 %, de 1,62 à 5,36) et une instabilité résidentielle (RC, 3,49; IC à 95 %, de 1,86 à 6,70). L’état d’activation du PP n’était pas associé à la dépendance ou à la concentration ethnique.

      Conclusions

      Dans notre population d’enfants et d’adolescents atteints du DT1, un état inactif sur le PP est associé à un plus haut degré de privation matérielle et à une instabilité résidentielle. D’autres études sur la façon dont ces facteurs influencent l’activation du PP et la façon d’améliorer l’équité en matière d’accès sont nécessaires.

      Keywords

      Mots clés

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