Online portals could improve health for adolescents
In an effort to improve communication with adolescent patients and provide a more confidential forum for test results and care, University of Florida Health researchers recently tested use of an electronic patient portal for adolescents. The researchers found adolescent patients, those between 12 and 18, used the portal at the same rate as parents of younger children, who can manage their children’s health care online until age 12 when adolescents receive private access to their health portal. The findings of the study were published today (Jan. 20) in the Journal of Adolescent Health.
"Our traditional methods of communicating with adolescents are inadequate," said Lindsay A. Thompson, M.D., an associate professor of pediatrics and health outcomes and policy in the UF College of Medicine. "We need a better way to communicate, especially when confidentiality is a concern. A lot of institutions across the country are struggling with how to do this."
UF Health researchers tested teens’ use of the portal over a two-and-a-half year period, comparing their usage patterns to those of parents of children 11 and under. During that time, adolescents showed the same "click-thru" patterns as parents of younger patients and were just as likely to enroll in the portal and review lab tests and medications as these parents. Adolescents were less likely to send messages to their providers; only 37 percent of adolescents sent private messages compared with 84 percent of parents of younger children, but researchers were pleased with the number of messages teens sent.
An electronic patient portal offers numerous benefits to adolescents, starting with increased confidentiality. Because adolescents still live with parents and guardians, calling with results for sensitive tests, such as those for sexually transmitted diseases, can be problematic for health care providers, who could unknowingly break confidentiality if a parent is listening. Any breach in confidentiality is illegal under Florida law, as it is in most states, even for children under the age of 18.
Thompson said starting around age 11, generalists and pediatricians begin asking parents to leave their children’s appointments so that the physicians can begin asking questions that may be sensitive. With certain tests and medications, such as refills for birth control pills, some adolescents won’t participate unless they are ensured confidentiality, Thompson said.
"We understand how uncomfortable and new it is, having part of an appointment without a parent," Thompson said. "But not only is it legally correct, it’s also a good learning experience for teens."
Accessing their own portal and communicating with physicians directly helps prepare adolescents for managing their own health care as adults. Using such a system could also help pave the way for better health care in young adulthood, Thompson said.
"Learning to ask a question and process the response in an email format that is protected is ideal, because in this day and age, that is how teens seek information anyway," Thompson said. "I think one of the biggest barriers to transition to adult services is figuring out how to access preventive care. Young adults don’t see their physicians for preventive care as often as they should and this could improve that."
In the age of "helicopter" parenting, one might suspect that parents would be resistant to teens managing their own care online, but this was not the case, Thompson said. Parents, she said, seem to understand how important it is for their adolescents to begin to gain the skills needed to communicate with doctors. Also, parents can still make appointments for their children. They just need to call to do so instead of making an appointment online as they might for themselves or their younger children.
Moving forward, UF Health researchers hope to expand the portal, perhaps making it more visually appealing to adolescents and increasing their ability to access and search for health information confidentially. They also hope to use it as a way to reach adolescents about health risks, such as the use of e-cigarettes, and to encourage them to come in for routine checkups.
Research from the Pew Research Center shows that 92 percent of teens say they go online daily and more than half report texting as their preferred method of communication, with social media the second most preferred form.
"If we can do (a portal) the right way, we can put it in a format as attractive as social media," Thompson said. "We need to have focus groups with teens themselves to find out what would work. Using this could be a fun, exciting way to get teens to pay attention to health."