Patient-Physician Messaging by Race, Ethnicity, Insurance Type, and Preferred Language.

Area of Science:

• Health Informatics
• Health Equity
• Primary Care Research

Background:

• Asynchronous patient-portal messaging is crucial for patient-physician communication.
• Existing disparities in patient-physician communication response patterns are not well understood.

Purpose of the Study:

• To investigate variations in asynchronous messaging response patterns within primary care.
• To analyze these variations based on patient race and ethnicity, insurance type, and primary language.

Main Methods:

• Cross-sectional study utilizing messaging data from 341,836 adult patients in primary care.
• Analysis included response receipt within 1 or 3 business days and time to first response.
• Multivariable regression models adjusted for patient demographics, clinic, and time fixed effects.

Main Results:

• Significant disparities were observed in care team response rates and timing based on patient characteristics.
• Black and Hispanic patients experienced lower response rates within 1 business day compared to White patients.
• Patients with dual-eligibility insurance and those preferring Spanish also showed lower response rates compared to commercially insured and English-preferring patients, respectively.

Conclusions:

• Significant disparities exist in primary care team responsiveness to asynchronous patient portal messages.
• These inequities are linked to patient race/ethnicity, insurance status, and preferred language.
• Slower response times at practices serving underserved populations partially explain these observed disparities.