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Use of e-Health Services between 1999 and 2002: A Growing Digital Divide

Affiliations of the authors: Kaiser Permanente Medical Care Program, Oakland, CA (JHs, JHu, JK, BF, JS); University of California, San Francisco, San Francisco, CA (RM); Veterans Affairs Medical Center, Washington, DC (EO).

Correspondence and reprints: John Hsu, MD, MBA, MSCE, 2000 Broadway, 3rd Floor, Oakland, CA 94612; e-mail: <jth{at}dor.kaiser.org>.

Received for publication: 08/13/04; accepted for publication: 11/01/04.

Objective: To evaluate the patterns of e-Health use over a four-year period and the characteristics of users.

Design: Longitudinal, population-based study (1999–2002) of members of a prepaid integrated delivery system. Available e-Health services included ordering prescription drug refills, scheduling appointments, and asking medical questions.

Measurements: Rates of known access to e-Health services, and of e-Health use each quarter.

Results: The number of members with known e-Health access increased from 51,336 (1.6%) in 1999 to 324,522 (9.3%), in 2002. The percentage of households in which at least one person in the household had access increased from 2.7% to 14.1%. Among the subjects with known access, the percentage of subjects that used e-Health at least once increased from 25.7% in 1999 to 36.2% in 2002. In the multivariate analysis, subjects who had a low expected clinical need, were nonwhite, or lived in low socioeconomic status (SES) neighborhoods were less likely to have used e-Health services in 2002. Disparities by race/ethnicity and SES persisted after controlling for access to e-Health and widened over time.

Conclusion: Access to and use of e-Health services are growing rapidly. Use of these services appears to be greatest among persons with more medical need. The majority of subjects, however, do not use any e-Health services. More research is needed to determine potential reasons for disparities in e-Health use by race/ethnicity and SES as well as the implications of these disparities on clinical outcomes.

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