E-mail communications in primary care: what are patients’ expectations for specific test results?

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Summary

Objectives:

The objectives of this study were to assess patients’ willingness to use e-mail to obtain specific test results, assess their expectations regarding response times, and identify any demographic trends.

Methods:

A cross-sectional survey of primary care patients was conducted in 19 clinics of a large multi-specialty group practice associated with an 186,000-member Health Maintenance Organization. The outcome measures were proportion of patients with current e-mail access, their willingness to use it for selected general clinical services and to obtain specific test results, and their expectations of timeliness of response.

Results:

The majority of patients (58.3%) reported having current e-mail access and indicated strong willingness to use it for communication. However, only 5.8% reported having ever used it to communicate with their physician. Patients were most willing to use e-mail to obtain cholesterol and blood sugar test results, but less willing to use it to obtain brain CT scan results. Patients’ expectations of timeliness were generally very high, particularly for high-stakes tests such as brain CT scan. Significant differences of willingness and expectations were found by age group, education, and income.

Conclusions:

These findings indicate that most patients are willing to use e-mail to communicate with their primary care providers even for specific test results and that patients will hold providers to high standards of timeliness regarding response. The implication is that integration of e-mail communications into primary care ought to assure prompt and accurate patient access to a plethora of specific clinical services.

Introduction

Although the use of e-mail has the potential to transform communications in primary care [1], [2], [3], providers and health care administrators need a better understanding of patient preferences and concerns that might impact their use of this innovative communication tool. This understanding is essential in order for providers and health care administrators to develop the most useful and cost-effective systems for communicating health care information. After all, the use of e-mail to communicate in the healthcare setting has both advantages [4], [5] and some significant potential disadvantages [5], [6].

Prior research on e-mail communications in primary care has indicated that a large proportion of patients in the primary care setting has access to e-mail and would use it to communicate with their health care providers, including their primary care physicians (PCPs) [7], [8], [9], [10], [11], [12]. In a pilot study in our own healthcare system using patients from 6 of our 18 regional clinics, 54.3% of the patients surveyed reported having access to e-mail communication, with a wide variation by clinic [9]. This statistic is similar to what has been reported in other settings [7], [10], [11]. Although 8 in 10 patients expressed the desire to use e-mail to obtain laboratory results or test reports in our pilot study, we found significant variation by race/ethnicity. African–American patients were somewhat less willing than others to use e-mail to obtain laboratory results or test reports. We also found significant variation in patient expectations for the timeliness of responses by age group and annual family income. Younger patients and those with annual family incomes at the two extremes (<US$ 10,000 and US$ 70,000+) had significantly higher expectations for the timeliness of responses to their e-mail queries on laboratory results or test reports than older patients and those in the middle income brackets [9]. These findings prompted the hypothesis that patients may vary both in their willingness to use e-mail to obtain specific test results and the timeliness of responses to their e-mail queries.

The objectives of the present study were to assess patients’ willingness to use e-mail for communications about specific test results, assess their expectations for response times to their e-mail queries, identify any demographic correlates associated with these preferences, and corroborate our previous findings on e-mail access and willingness to use it for selected general clinical services [9]. The present study included a larger sample of patients from all 18 regional clinics of our healthcare system as well as our largest hospital-based primary care clinic, the Community Internal Medicine (CIM) Clinic, located at the main site. The specific tests investigated were blood sugar, bone scan for osteoporosis, brain CT scan, cholesterol, cardiac (exercise) stress test, mammography, and prostate cancer screening using PSA. Therefore, the added values of the present study over our previous pilot study [9] were the increased sample size that covered a wider geographic area and the focus on specific tests for a number of common conditions that present in the primary care setting.

Section snippets

Study design and setting

This study was a cross-sectional, in-person prevalence survey of primary care patients seen in 19 clinics of the Scott & White Healthcare System, which is a large multi-specialty, university-affiliated group practice associated with an 186,000-member Health Maintenance Organization in Central Texas. The clinics are all located within 100 miles of Temple, the site of the parent organization, the Scott & White Memorial Hospital. Three of the clinics – Northside Clinic, Santa Fe Clinic, and the

Response rates and study participants

Of 3625 total patients seen at all the clinics during the study period and approached for participation, 2817 consented to participate. However, only 2314 (82.1%) returned complete surveys. There were no statistically significant differences by clinic between the number of patients who consented and those who did not consent and between those who returned completed surveys and those who did not. Forty-six subjects younger than 18 years and eight Spanish-speaking subjects were excluded from data

Discussion

The Internet and e-mail have powerful potential to change the ways in which primary care physicians and their patients communicate health care information [13], [14], [15], [16], [17], [18] just as the incorporation of the telephone into medical practice changed the lives of physicians forever. However, studies of cyber-medicine and e-health have also indicated that attempts to integrate this emerging information technology into the healthcare environment have been too technology focused and

Acknowledgments

This research was supported by a Scott & White Institutional Research Fund. We are indebted to the clinic medical directors, operations managers, clinic supervisors and registration clerks. We also thank Sandy Mason for study coordination and Marcine Chambers for secretarial support.

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