The Future of Community Outreach: Using Patient Portals to Provide Voter Resources during the Coronavirus Disease 2019 Pandemic

Abstract

Background During the coronavirus disease 2019 (COVID-19) pandemic, there was a concern for the 2020 general election becoming a superspreader event due to in-person voting.

Objectives Our project addressed this concern by disseminating nonpartisan websites detailing safe voter options in the state of North Carolina to prevent community spread of the virus as much as possible.

Methods In this study, patient portals were used to disseminate a Research Electronic Data Capture survey containing embedded links to voter resources including nonpartisan websites discussing voting options. The survey also asked for demographic data and sentiments regarding the resources provided. Quick response (QR) codes with the survey link were also placed in the clinics during the study period.

Results The survey was sent to 14,842 patients who had at least one patient encounter in the past 12 months at one of three General Internal Medicine clinics at Atrium Health Wake Forest Baptist. Survey participation through both the patient portals and QR codes was assessed. Patient sentiments toward the voter resources in regard to (1) interest and (2) perceived helpfulness were collected in the survey. In total, 738 (4.99%) patients filled out the survey. Eighty-seven percent of survey respondents reported that the voter resources were helpful. Significantly more black patients than white (29.3 vs. 18.2, p < 0.05) voiced interest in voter resources. There was no statistical significance across gender or reported comorbidities.

Conclusion Multicultural, underserved, and underinsured patients perceived the most benefit. During public health crises, patient portal messages can be used to bridge information gaps and promote better health outcomes in a timely and effective manner.

Keywords

patient portals - voter registration - social determinants of health - COVID-19 - community outreach

Protection of Human and Animal Subjects

The study was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects and was reviewed by Wake Forest University Health Sciences Institutional Review Board.

Publication History

Received: 03 October 2022

Accepted: 23 January 2023

Article published online:
19 April 2023

• References

• 1 COVID-19 Map - Johns Hopkins Coronavirus Resource Center. Accessed July 8, 2021 at: https://coronavirus.jhu.edu/map.html
• 2 Frieden TR, Lee CT. Identifying and interrupting superspreading events-implications for control of severe acute respiratory syndrome coronavirus 2. Emerg Infect Dis 2020; 26 (06) 1059-1066
• 3 Schuchat A. Public Health Response to the Initiation and Spread of Pandemic COVID-19 in the United States, February 24–April 21, 2020. MMWR Morb Mortal Wkly Rep. 2020; 69 (18) -551 556
• 4 2020 State Primary Election Dates. Accessed July 14, 2021 at: https://www.ncsl.org/research/elections-and-campaigns/2020-state-primary-election-dates.aspx
• 5 [USC05] 3 USC Ch. 1: PRESIDENTIAL ELECTIONS AND VACANCIES. Accessed July 14, 2021 at: https://uscode.house.gov/view.xhtml?path=%2Fprelim%40title3%2Fchapter1&edition=prelim
• 6 In General | Constitution Annotated | Congress.gov | Library of Congress. Accessed July 14, 2021 at: https://constitution.congress.gov/browse/essay/artII-S1-C4-1/ALDE_00013599/
• 7 COVID-19 and 2020 Primary Elections. Accessed July 14, 2021 at: https://www.ncsl.org/research/elections-and-campaigns/state-action-on-covid-19-and-elections.aspx
• 8 Online voter registration - Ballotpedia. Accessed July 14, 2021 at: https://ballotpedia.org/Online_voter_registration
• 9 NW 1615 L. St, Suite 800Washington, Inquiries D 20036USA202 419 4300 | M 857 8562 | F 419 4372 | M. Two-Thirds of Americans Expect Presidential Election Will Be Disrupted by COVID-19. Pew Research Center - U.S. Politics & Policy. Published April 28, 2020. Accessed July 14, 2021 at: https://www.pewresearch.org/politics/2020/04/28/two-thirds-of-americans-expect-presidential-election-will-be-disrupted-by-covid-19/
• 10 Brown CL, Raza D, Pinto AD. Voting, health and interventions in healthcare settings: a scoping review. Public Health Rev 2020; 41: 16
• 11 Factors associated with voting. Accessed August 9, 2021 at: https://www150.statcan.gc.ca/n1/pub/75-001-x/2012001/article/11629-eng.htm
• 12 Raza D, Brown C, Pinto AD. Supporting patients to shape social determinants of health through democratic engagement. Can Fam Physician 2020; 66 (09) 639-641
• 13 Liggett A, Sharma M, Nakamura Y, Villar R, Selwyn P. Results of a voter registration project at 2 family medicine residency clinics in the Bronx, New York. Ann Fam Med 2014; 12 (05) 466-469
• 14 Implementation of a Medical Student-Led Emergency Absentee Ballot Voting Initiative at an Urban Tertiary Care University Hospital. Accessed July 14, 2021 at: https://www.acponline.org/membership/medical-students/acp-impact/archive/july-2019/implementation-of-a-medical-student-led-emergency-absentee-ballot-voting-initiative-at-an-urban
• 15 Core Beliefs. Vot-ER. Published May 13, 2020. Accessed July 14, 2021 at: https://vot-er.org/core-beliefs/
• 16 Kruse CS, Bolton K, Freriks G. The effect of patient portals on quality outcomes and its implications to meaningful use: a systematic review. J Med Internet Res 2015; 17 (02) e44
• 17 Casillas A, Abhat A, Mahajan A. et al. Portals of change: how patient portals will ultimately work for safety net populations. J Med Internet Res 2020; 22 (10) e16835
• 18 Fact Book 2019–20. Office of Institutional Research. Accessed August 9, 2021 at: https://ir.wfu.edu/fact-book/fact-book-2019-20/
• 19 CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. Published June 11, 2021. Accessed July 14, 2021 at: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html
• 20 myNCDMV. Accessed August 27, 2021 at: https://payments.ncdot.gov/
• 21 Voter Search. Accessed August 27, 2021 at: https://vt.ncsbe.gov/RegLkup/
• 22 How to Vote by Mail with an Absentee Ballot. NC Voter. Accessed August 27, 2021 at: https://www.ncvoter.org/absentee-ballots/
• 23 Where's My Ballot? Accessed August 27, 2021 at: https://wheresmyballot.com/
• 24 Kruse CS, Argueta DA, Lopez L, Nair A. Patient and provider attitudes toward the use of patient portals for the management of chronic disease: a systematic review. J Med Internet Res 2015; 17 (02) e40
• 25 Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015; 17 (06) e148
• 26 Osborn CY, Mayberry LS, Mulvaney SA, Hess R. Patient web portals to improve diabetes outcomes: a systematic review. Curr Diab Rep 2010; 10 (06) 422-435
• 27 Turer RW, Martin KR, Courtney DM. et al. Real-time patient portal use among emergency department patients: an open results study. Appl Clin Inform 2022; 13 (05) 1123-1130
• 28 Otokiti A, Williams KS, Warsame L. Impact of digital divide on the adoption of online patient portals for self-motivated patients. Healthc Inform Res 2020; 26 (03) 220-228
• 29 Casacchia NJ, Rosenthal GE, O'Connell NS. et al. Characteristics of adult primary care patients who use the patient portal: a cross-sectional analysis. Appl Clin Inform 2022; 13 (05) 1053-1062
• 30 Inc G. Do Quick Response Codes Enhance or Hinder Surveys? Gallup.com. Published August 30, 2018. Accessed June 23, 2021 at: https://news.gallup.com/opinion/methodology/241808/quick-response-codes-enhance-hinder-surveys.aspx
• 31 Perez-Alba E, Nuzzolo-Shihadeh L, Espinosa-Mora JE, Camacho-Ortiz A. Use of self-administered surveys through QR code and same center telemedicine in a walk-in clinic in the era of COVID-19. J Am Med Inform Assoc 2020; 27 (06) 985-986
• 32 NW 1615 L. St, Suite 800Washington, Inquiries D 20036USA202 419 4300 | M 857 8562 | F 419 4372 | M. Demographics of Mobile Device Ownership and Adoption in the United States. Pew Research Center: Internet, Science & Tech. Accessed June 23, 2021 at: https://www.pewresearch.org/internet/fact-sheet/mobile/
• 33 Kenning C, Coventry PA, Gibbons C, Bee P, Fisher L, Bower P. Does patient experience of multimorbidity predict self-management and health outcomes in a prospective study in primary care?. Fam Pract 2015; 32 (03) 311-316
• 34 Turnout. CAWP. Accessed June 23, 2021 at: https://cawp.rutgers.edu/facts/voters/turnout
• 35 Mattila M, Söderlund P, Wass H, Rapeli L. Healthy voting: the effect of self-reported health on turnout in 30 countries. Elect Stud 2013; 32 (04) 886-891
• 36 Gollust SE, Rahn WM. The bodies politic: chronic health conditions and voter turnout in the 2008 Election. J Health Polit Policy Law 2015; 40 (06) 1115-1155