Patient race/ethnicity and shared medical record use among diabetes patients.

BACKGROUND: Previous studies have documented racial/ethnic differences in patients' use of websites providing shared electronic medical records between patients and health care professionals. Less is known about whether these are driven by patient-level preferences and/or barriers versus broader provider or system factors. METHODS: Cross-sectional study of diabetes patients in an integrated delivery system in 2008-2009. Primary measures were race/ethnicity and shared medical record (SMR) use. Covariates included sociodemographics (age, sex, income, education), health status (comorbidity, diabetes severity), and provider characteristics (encouragement of SMR, secure messaging use, clinic). RESULTS: The majority (62%) of Whites used the SMR, compared with 34% of Blacks, 37% of Asians, and 55% of other race/ethnicity (P<0.001). Most respondents (76%) stated that their provider had encouraged them to use the SMR, with no differences by race/ethnicity. Patients saw primary care providers who used a similar amount of secure messaging in their practices-except Asians, who were less likely to see high-messaging providers. In fully adjusted models, Blacks [odds ratio (OR), 0.18; 95% confidence interval (CI), 0.11-0.30] and Asians (OR, 0.40; 95% CI, 0.20-0.77) were significantly less likely than Whites to use the SMR. When restricted to individuals reporting at least occasional Internet use, this finding remained for Black respondents (OR, 0.25; 95% CI, 0.10-0.63). CONCLUSIONS: Among diabetes patients, differences in SMR use by race/ethnicity were not fully explained by differences in age, sex, sociodemographics, health status, or provider factors-particularly for Black patients. There were few racial/ethnic differences in provider encouragement or provider secure messaging use that would have suggested disparities at the provider level.

Response to past depression treatments is not accurately recalled: comparison of structured recall and patient health questionnaire scores in medical records.

OBJECTIVE: Assessing response to prior depression treatments is common in research and clinical practice, but few data are available regarding accuracy of patient recall. Data from a population-based survey were linked to electronic medical records to examine agreement between patients' recalled treatment response and depression severity scores in the medical records. METHOD: Electronic medical records from a large health system identified 1,878 adult patients with 2 or more episodes of clinician-diagnosed major depressive disorder or dysthymia between January 2005 and December 2009 (diagnoses had been recorded using ICD-9 codes). These potential participants were mailed an invitation letter, and, of these, 578 completed an online or mailed survey including structured recall of response to each prior depression treatment, rating both global improvement during treatment and improvement specifically attributed to treatment. For 269 of the survey participants, at least 1 treatment episode could be unambiguously linked to both pretreatment and posttreatment Patient Health Questionnaire (PHQ-9) depression scores in the electronic medical records. Analyses examined the agreement between patients' recall of treatment response and response according to PHQ-9 scores from the medical records. RESULTS: Agreement between recall and the medical records was poor for both overall improvement following treatment (κ = 0.10; 95% CI, 0.00-0.19) and improvement attributed to treatment (κ = 0.12; 95% CI, 0.00-0.25). Agreement remained poor when the sample was limited to medication treatment episodes, episodes lasting 3 months or more, or episodes for which the participant was "very sure" of his or her ability to recall. Agreement reached a fair level only for episodes in the 6 months prior to the survey, for both overall improvement (κ = 0.23; 95% CI, 0.08-0.39) and improvement attributed to treatment (κ = 0.36; 95% CI, 0.12-0.59). CONCLUSIONS: Patients' recall of response to past depression treatments agrees poorly with data from medical records. Interview assessment of prior treatment response may not be a useful tool for research or clinical practice.