Role of Online Patient Portal Self-Scheduling and Self-Referral Pathways to Decrease Health Disparity for Screening Mammography

J Am Coll Radiol. 2023 Jul 27:S1546-1440(23)00534-3. doi: 10.1016/j.jacr.2023.06.027. Online ahead of print.


Purpose: The aim of this study was to assess the rate of self-scheduling and self-referral for screening mammography (SM) and to assess sociodemographic factors associated with their use in an academic health care system in southern California.

Methods: Patients scheduled for SM between February 1, 2021, and September 20, 2022, were included in this retrospective study. Multivariable logistic regression models were used to assess associations among sociodemographic factors, self-referral, and online self-scheduling pathways.

Results: In total, 22,306 patients were scheduled for SM (mean age, 59 years; 66.8% white, 20.4% Asian, and 20.6% Hispanics). Overall, 3,566 (16.0%) used online self-scheduling, and 1,232 (5.5%) self-referred for SM. Patients 70 years or older (vs 50 years or younger) (OR, 0.41; 95% CI, 0.34-0.51), Spanish (vs English) speakers (OR, 0.22; 95% CI, 0.16-0.31), and those on Medicaid (vs commercially insured) (OR, 0.71; 95% CI, 0.50-0.99) were less likely to self-schedule. Hispanics (vs non-Hispanics) (OR, 1.39; 95% CI, 1.20-1.61), Asians (vs whites) (OR, 1.64; 95% CI, 1.46-1.85), and patients residing in the most (vs least) disadvantaged neighborhoods (OR, 1.16; 95% CI, 1.02-1.33) were more likely to self-schedule. Furthermore, patients 70 years or older (vs 50 or younger) (OR, 0.70; 95% CI, 0.52-0.93) and Spanish speakers (OR, 0.05; 95% CI, 0.03-0.09) were less likely to self-refer, whereas blacks (vs whites) (OR, 1.89; 95% CI, 1.30-2.75), patients on Medicaid (vs commercially insured) (OR, 3.70; 95% CI, 2.65-5.13), and patients living in the most (vs least) disadvantaged neighborhoods (OR, 1.52; 95% CI, 1.27-1.82) were more likely to self-refer.

Conclusions: Sociodemographic differences in online patient portal use and self-referral for SM suggest that the two pathways have been successful in addressing some of the existing scheduling barriers and are a step toward closing the disparity gap.

Keywords: Screening mammography; health disparity; self-referral; self-schedule.