1. This study found that veterans experiencing homelessness use secure messaging to their health care providers at lower rates than expected.
2. Certain groups of veterans experiencing homelessness, such as females and those with college education, were more likely to use secure messaging.
Evidence Rating Level: 2 (Good)
People who have experienced homelessness may have significant barriers to medical care, such as transportation difficulties as well as frequent changes of address and telephone numbers. Secure messaging between patients and their health care providers through patient health portals may be one way to mitigate this issue. However, it is currently unknown whether veterans who have experienced homelessness (VEHs) use these messaging systems and what barriers they may face. This is particularly relevant during the COVID-19 pandemic, which has decreased in-person office visits.
This study was a cross-sectional analysis of the 2018 Primary Care Homeless Services Tailoring survey from March to October 2018. Surveys were mailed to a stratified random sample of VEHs at 26 Veterans Affairs medical centers within the United States. Only patients who responded to the secure messaging items were included (n=5072). Patients were excluded for any missing data. Outcome variables included use of secure messaging in the My HealtheVet system and various other correlates including age, gender, race, education, and others.
The results show that only 21% of VEHs used secure messaging. Amongst those who used the platform (commonly female, had college education, 3 or more chronic medical conditions), 87% of them found the technology useful. Those who were older, black, or had substance use disorders were less likely to use the platform. However, this study was limited considering its modest response rate of 40.2%. Furthermore, patient interest in web-based telehealth was not assessed in this study. Nonetheless, this study was significant in suggesting that barriers may exist to secure messaging between patients and providers which have led to concerning disparities in healthcare.
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