Journal of Racial and Ethnic Health Disparities

, Volume 5, Issue 6, pp 1373–1380 | Cite as

A Digital Language Divide? The Relationship between Internet Medication Refills and Medication Adherence among Limited English Proficient (LEP) Patients

  • Alejandra CasillasEmail author
  • Gerardo Moreno
  • Jonathan Grotts
  • Chi-Hong Tseng
  • Leo S. Morales



Use of an Internet portal to refill medicines positively affects medication adherence among English-speakers. No prior studies, however, have specifically examined the relationship between Internet refills and medication adherence among patients who are limited English proficient (LEP).


(1) Examine the relationship between Internet medication refill system use and medication adherence among linguistically diverse patients with chronic conditions and (2) compare this relationship between LEP and English-proficient (EP) patients.

Design, Participants, Measures

We analyzed 2013–2014 cross-sectional data from 509 surveyed adults in the Group Health Cooperative. Surveys were merged with plan enrollment, claims data, and electronic medical records. Medication adherence was calculated by the “Continuous Measure of Medication Gaps” (CMG) method. For Internet refill system use, patients were asked, “Have you used the health systems Internet site to refill any medications in the last 12 months?” LEP status was captured in the electronic medical record by a non-English primary language and a claims record of interpreter use in at least one clinical encounter between 2005 and 2012. We used multivariate linear regression models to examine Internet refill system use and medication adherence and compared the association between LEP and EP patients.


Three hundred eighty-four patients (75%) had a calculable CMG: 134 EP and 250 LEP in the adherence analyses. In unadjusted analyses, LEP patients had lower use of the Internet refill system (p < .001) and lower adherence versus the EP group (p < .001). In multivariate analyses, LEP status (β = − 0.022, p = .047) was negatively associated with adherence, while use of the Internet refill system (β = 0.030, p = .002) was positively associated. In stratified models, use of Internet refills was positively associated with adherence, even when examining LEP (β = 0.029, p = .003) and EP patients (β = 0.027, p = .049) separately.


These findings suggest that LEP patients may be under-utilizing a beneficial Internet tool. Should our healthcare systems fail to ensure that LEP patients have full and meaningful access to Internet patient portals, we risk worsening healthcare disparities.


Limited English proficiency Digital divide Health disparities Patient portal Medication adherence 



Contributors: Authors listed, no others.

Prior Presentations: Casillas A, Moreno G, Tseng CH, Grotts J, and L Morales. A digital language divide? The relationship between Internet medication fills and medication adherence among Limited English Proficient patients. Oral Research Presentation. Society of General Internal Medicine Annual Meeting. April 2017 in Washington DC.


This research was supported by R01MD006185 (PI: Morales). Alejandra Casillas MD, MSHS, also received support from the University of California, Los Angeles (UCLA) and Charles Drew University (CDU), resource Centers for Minority Aging Research Center for Health Improvement of Minority Elderly (RCMAR/CHIME) under the NIH/NIA Grant P30-AG021684, and from the UCLA Clinical and Translational Science Institute (CTSI) under the NIH/NCATS Grant Number UL1R001881. The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the NIH.

Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© W. Montague Cobb-NMA Health Institute 2018

Authors and Affiliations

  • Alejandra Casillas
    • 1
    Email author
  • Gerardo Moreno
    • 2
  • Jonathan Grotts
    • 1
  • Chi-Hong Tseng
    • 1
  • Leo S. Morales
    • 3
  1. 1.Division of General Internal Medicine and Health Services Research, Department of MedicineUCLA David Geffen School of MedicineLos AngelesUSA
  2. 2.Department of Family MedicineUCLA David Geffen School of MedicineLos AngelesUSA
  3. 3.Center for Health Equity, Diversity and InclusionUniversity of Washington School of MedicineSeattleUSA

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