Introduction: Patient portals are online platforms for accessing healthcare records,
prescriptions, and appointments, and are available in all General Practice (GP) practices
providing National Health Service (NHS) services in England. This thesis aims to study the
use and associations of patient portals in this context and explore healthcare-related
outcomes, offering clinical and policy recommendations.
Methods: A systematic review was performed to determine health and healthcare utilisation
outcomes associated with patient portals among patients with diabetes. An analysis of the GP
Patient Surveys (GPPS) of 2018-2020 was performed to explore characteristics associated
with patient portal use in England. An analysis of Clinical Practice Research Datalink
(CPRD), was performed to evaluate the number of consultations and statin prescription
ordering adherence before and after patient portal registration.
Results: The systematic review concluded that patient portal use is associated with health and
healthcare utilisation outcomes. Analyses of the GPPS surveys indicated that respondents
with long-term conditions (compared to those without), of the age groups 16 years old until
84 years old (compared to those aged 85 years and older), and of the lowest deprivation level
(compared to those in the highest level) were more likely to use patient portals. The
exploration of health utilisation indicated a reduced number of face-to-face consultations
(incidence rate ratio (IRR): 0.93, 95% confidence interval (CI): 0.93, 0.94), but an increased
number of remote consultations after portal registration (IRR: 1.16, 95% CI: 1.15, 1.18).
Additionally, there was a reduction in statin prescription ordering adherence (of at least 80%)
after portal registration (IRR: 0.84, 95% CI: 0.81, 0.86).
Conclusion: Patient portals are useful tools, but there is a need to further explore and address
any existing inequalities, and unintended outcomes associated with their use. Future research
could explore inequalities and the mechanisms between patient portal use and outcomes.