Little is known about online medical record (OMR) use among caregivers, including changes in OMR use through the COVID-19 pandemic. This study compares OMR use among caregivers and non-caregivers before and during the COVID-19 pandemic, identifies reasons for non-use, and examines the association between caregiving status and characteristics with OMR use. Secondary data analysis of the nationally representative Health Information National Trends Survey data from 2018 to 2022 (n = 14,034). Caregivers were more likely to use the OMR post-COVID (51.8%) compared with pre-COVID (44.7%). Caregiving was significantly associated with increased likelihood of OMR use post-COVID (odds ratio = 1.67), but not pre-COVID. The increased use of OMR among caregivers during COVID-19 highlights the potential of OMRs as a support tool for caregivers’ health and well-being. Interventions and policies to improve OMR engagement must address persisting disparities across demographic groups and encourage caregivers’ OMR use to support their role and enhance their personal health management.
AhmedN.SanghaviK.MathurS.McCullersA. (2023). Patient portal use: Persistent disparities from pre- to post-onset of the COVID-19 pandemic. International Journal of Medical Informatics, 178, 105204.
AnthonyD. L.Campos-CastilloC.LimP. S. (2018). Who isn’t using patient portals and why? Evidence and implications from a national sample of US adults. Health Affairs, 37(12), 1948–1954.
4.
ArcherJ.ReiboldtW.ClaverM.FayJ. (2021). Caregiving in quarantine: Evaluating the impact of the COVID-19 pandemic on adult child informal caregivers of a parent. Gerontology and Geriatric Medicine, 7, 2333721421990150.
5.
BaoC.BardhanI. R.SinghH.MeyerB. A.KirkseyK. (2020). Patient-provider engagement and its impact on health outcomes: A longitudinal study of patient portal use. MIS Quarterly, 44(2), 699–723.
6.
BarwiseA.HuschkaT.WooC.EggintonJ.HuangL.AllenJ.JohnsonM.HammK.WolfersteigW.PhelanS.AllyseM. (2023). Perceptions and use of telehealth among diverse communities: Multisite community-engaged mixed methods study. JMIR, 25, Article e44242.
7.
BleckerS.JonesS. A.PetrilliC. M. (2021). Hospitalizations for chronic disease and acute conditions in the time of COVID-19. JAMA Internal Medicine, 181(2), 269–271.
8.
BratchesR. W. R.FreundlichN. Z.Dionne-OdomJ. N.O’MalleyA. J.BarrP. J. (2022). Perceptions of the impact of COVID-19 on healthcare communication in a nationally representative cross-sectional survey of family caregivers. BMJ Open, 12, Article e051154.
9.
Campos-CastilloC. (2015). Revisiting the first-level digital divide in the United States: Gender and race/ethnicity patterns, 2007-2012. Social Science Computer Review, 33(4), 423–439. https://doi.org/10.1177/0894439314547617
10.
ColemanE. A. (2016). Family caregivers as partners in care transitions: The caregiver advise record and enable act. Journal of Hospital Medicine, 11, 883–885.
11.
DangS.PenneyL. S.TrivediR.NoelP. H.PughM. J.FinleyE.PughJ. A.Van HoutvenC. H.LeykumL. (2020). Caring for caregivers during COVID-19. Journal of the American Geriatrics Society, 68(10), 2197–2201.
12.
Del-Pino-CasadoR.Priego-CuberoE.Lopez-MartinezC.OrgetaV. (2021). Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis. PLOS ONE, 16(3), Article e0247143.
13.
EganK. J.HodgsonW.ImperatoreG.DunlopM. D.MaguireR.KirkA. (2022). Supporting physical activity for informal caregivers during and beyond COVID-19: Exploring the feasibility, usability and acceptability of a digital health smartphone application, “CareFit.” International Journal of Environmental Research and Public Health, 19(19), 12506.
14.
GoldbergE. M.LinM. P.BurkeL. G.JimenezF. N.DavoodiN. M.MerchantR. C. (2022). Perspectives on Telehealth for older adults during the COVID-19 pandemic using the quadruple aim: Interviews with 48 physicians. BMC Geriatrics, 22, Article 188.
15.
GovierD. J.Cohen-ClineH.MarsiK.RothS. E. (2022). Differences in access to virtual and in-person primary care by race/ethnicity and community social vulnerability among adults diagnosed with COVID-19 in a large, multi-state health system. BMC Health Services Research, 22, Article 511.
16.
GraetzI.GordonN.FungV.HamityC.ReedM. E. (2016). The digital divide and patient portals: Internet access explained differences in patient portal use for secure messaging by age, race, and income. Medical Care, 54(8), 772–779. https://doi.org/10.1097/mlr.0000000000000560
17.
GraetzI.HuangJ.MuellyE. R.FiremanB.HsuJ.ReedM. E. (2020). Association of mobile patient portal access with diabetes medication adherence and glycemic levels among adults with diabetes. JAMA Network Open, 3(2), Article e1921429.
18.
Health Information National Trends Survey. (2023). National Cancer Institute. https://hints.cancer.gov
IottB.RajM.PlattJ.AnthonyD. (2020). Family caregiver access of online medical records: Findings from the Health Information National Trends Survey. Journal of General Internal Medicine, 35(11), 3267–3269.
22.
KentE. E.OrnsteinK. A.Dionne-OdomJ. N. (2020). The family caregiving crisis meets an actual pandemic. Journal of Pain and Symptom Management, 60(1), 66–69.
23.
KruseC. S.ArguetaD. A.LopezL.NairA. (2015). Patient and provider attitudes toward the use of patient portals for the management of chronic disease: A systematic review. JMIR, 17(2), Article e40.
24.
LatulipeC.QuandtS. A.MeliusK. A.BertoniA.MillerD. P.Jr.SmithD.ArcuryT. A. (2018). Insights into older adult patient concerns around the caregiver proxy portal use: Qualitative interview study. JMIR, 20(11), Article e10524.
25.
LeggettA.KooH. J.ParkB.ChoiH. (2022). The changing tides of caregiving during the COVID-19 pandemic: How decreasing and increasing care provision relates to caregiver well-being. Journals of Gerontology Series B, 77(1), S86–S97.
26.
LiY.CenX.CaiX.Temkin-GreenerH. (2020). Racial and ethnic disparities in COVID-19 infections and deaths across U.S. nursing homes. Journal of the American Geriatrics Society, 68(11), 2454–2461.
27.
LightfootE.MooneR. (2020). Caregiving in times of uncertainty: Helping adult children of aging parents find support during the COVID-19 outbreak. Journal of Gerontological Social Work, 63(6–7), 542–552.
28.
LongacreM. L.KeleherC.ChwistekM.OdelbergM.SiemonM.CollinsM.FangC. Y. (2021). Developing an integrated caregiver patient-portal system. Healthcare, 9(2), 193.
29.
National Academies of Science Engineering and Medicine. (2016). Families caring for an aging America.
30.
National Alliance for Caregiving. (2023). Policy brief: How the 2024 Medicare Physician Fee Schedule advances supports for family caregivers.
31.
NishiiA.Campos-CastilloC.AnthonyD. (2022). Disparities in patient portal access by US adults before and during the COVID-19 pandemic. JAMIA Open, 5(4), ooac104.
32.
NortonE. C.DowdB. E.GarridoM. M.MaciejewskiM. L. (2024). Requiem for odds ratios. Health Services Research, 59(4), Article e14337.
33.
OlsenJ. (2021). Caregivers are missing from the long COVID conversation. STAT.
34.
PecinaJ.DuvallM. J.NorthF. (2020). Frequency of and factors associated with care partner proxy interaction with health care teams using patient portal accounts. Telemedicine Journal and E-Health, 26(11), 1368–1372.
35.
PenningM. J.WuZ. (2016). Caregiver stress and mental health: Impact of caregiving relationship and gender. The Gerontologist, 56(6), 1102–1113.
36.
RajM.IottB.AnthonyD.PlattJ. (2020). Family caregivers’ experiences with telehealth during COVID-19: Insights from Michigan. Annals of Family Medicine, 20(1), 69–71.
37.
RajM.StephensonA. L.DePuccioM. J.SullivanE. E.TarverW.FleurenB.ThomasS. C.McAlearneyA. S. (2022). Conceptual framework for integrating family caregivers into the health care team: A scoping review. Medical Care Research and Review, 80(2), 131–144.
38.
RichwineC.JohnsonC.PatelV. (2023). Disparities in patient portal access and the role of providers in encouraging access and use. Journal of the American Medical Informatics Association, 30(2), 308–317.
39.
SchulzR.BeachS. R. (1999). Caregiving as a risk factor for mortality: The Caregiver Health Effects Study. JAMA, 282(23), 2215–2219. https://doi.org/10.1001/jama.282.23.2215
40.
SchulzR.SherwoodP. (2008). Physical and mental health effects of family caregiving. The American Journal of Nursing, 108(9), 23–27.
41.
SemereW.AlthouseA. D.RoslandA.-M.WhiteD.ArnoldR.ChuE.SmithT. J.SchenkerY. (2021). Poor patient health is associated with higher caregiver burden for older adults with advanced cancer. Journal of Geriatric Oncology, 12(5), 771–778.
42.
ShahS. D.LiebovitzD. (2017). It takes two to tango: Engaging patients and providers with portals. Clinical Informatics in Physiatry, 9, 85–97.
43.
ShaverJ. (2022). The state of telehealth before and after the COVID-19 pandemic. Primary Care, 49(4), 517–530.
44.
SteinmanM. A.PerryL.PerissinottoC. M. (2020). Meeting the care needs of older adults isolated at home during the COVID-19 pandemic. JAMA Internal Medicine, 180(6), 819–820. https://doi.org/10.1001/jamainternmed.2020.1661
45.
StewartM. T.HoganT. P.NicklasJ.RobinsonS. A.PuringtonC. M.MillerC. J.VimalanandaV. G.ConnollyS. L.WolfeH. L.NazyK. M.NethertonD.ShimadaS. L. (2020). The promise of patient portals for individuals living with chronic illness: Qualitative study identifying pathways of patient engagement. JMIR, 22(7), Article e17744.
VatchevaK. P.LeeM. J.McCormickJ. B.RahbarM. H. (2016). Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology, 6(2), 227.
48.
WhaleyC. M.PeraM. F.CantorJ. (2020). Changes in health services use among commercially insured US populations during the COVID-19 pandemic. JAMA Network Open, 3(11), Article e2024984.
49.
The White House. (2023). FACT SHEET: Biden-Harris administration announces most sweeping set of executive actions to improve care in history.
50.
WolffJ. L.SpillmanB. C.FreedmanV. A.KasperJ. D. (2016). A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Internal Medicine, 176(3), 372–379. https://doi.org/10.1001/jamainternmed.2015.7664
51.
XuL.LiuY.HeH.FieldsN. L.IveyD. L.KanC. (2021). Caregiving intensity and caregiver burden among caregivers of people with dementia: The moderating roles of social support. Archives of Gerontology and Geriatrics, 94, 104334.
52.
YiS. S.KwonS. C.SussR.DoanL. N.JohnI.IslamN. S.Trinh-ShevrinC. (2022). The mutually reinforcing cycle of poor data quality and racialized stereotypes that shapes Asian American health. Health Affairs, 41(2), 296–303.
53.
YoonE.HurS.OpsasnickL.HuangW.BatioS.CurtisL. M.BenaventeJ. Y.Lewis-ThamesM. W.LiebovitzD. M.WolfM. S.SerperM. (2024). Disparities in patient portal use among adults with chronic conditions. JAMA Network Open, 7(2), Article e240680.
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