Patient Access to U.S. Physicians Who Conduct Internet or E-mail Consults

BACKGROUND: E-mail communication has the potential to improve communication between patients and doctors. OBJECTIVE: The objective of the study is to describe the access of patients to physicians who conduct e-mail consults. METHODS: We analyzed data from the National Ambulatory Medical Care Survey (NAMCS), a nationally representative cross-sectional survey of office-based physician visits, in 2001, 2002, and 2003. The main outcome measure was the percentage of visits to a provider who reported doing internet or e-mail consults. RESULTS: There was fewer than 1 in 10 outpatient visits in 2001 (9.2%) to physicians who reported doing internet or e-mail consults, and this did not increase in 2002 (5.8%) or 2003 (5.5%). Access to these physicians was greater among patients who were male, nonminority, lived in the Western United States, seen for pre-/postoperative care, seen by a primary care provider, and not seen by a nurse during their visit. Access to physicians who conducted internet or e-mail consults was independent of other patient (e.g., chronic conditions), provider (e.g., office setting), and visit (e.g., medications prescribed) characteristics. CONCLUSIONS: Access to physicians who do internet or e-mail consults is generally low and did not increase between 2001 and 2003, despite growth in internet access and in other internet-related activities

Benefits and costs of digital consulting in clinics serving young people with long-term conditions : mixed-methods approach

Background Since the introduction of digital health technologies in National Health Service (NHS), health professionals are starting to use email, text, and other digital methods to consult with their patients in a timely manner. There is lack of evidence regarding the economic impact of digital consulting in the United Kingdom (UK) NHS. Objective This study aimed to estimate the direct costs associated with digital consulting as an adjunct to routine care at 18 clinics serving young people aged 16-24 years with long-term conditions. Methods This study uses both quantitative and qualitative approaches. Semistructured interviews were conducted with 173 clinical team members on the impacts of digital consulting. A structured questionnaire was developed and used for 115 health professionals across 12 health conditions at 18 sites in the United Kingdom to collect data on time and other resources used for digital consulting. A follow-up semistructured interview was conducted with a single senior clinician at each site to clarify the mechanisms through which digital consulting use might lead to outcomes relevant to economic evaluation. We used the two-part model to see the association between the time spent on digital consulting and the job role of staff, type of clinic, and the average length of the working hours using digital consulting. Results When estimated using the two-part model, consultants spent less time on digital consulting compared with nurses (95.48 minutes; P<.001), physiotherapists (55.3 minutes; P<.001), and psychologists (31.67 minutes; P<.001). Part-time staff spent less time using digital consulting than full-time staff despite insignificant result (P=.15). Time spent on digital consulting differed across sites, and no clear pattern in using digital consulting was found. Health professionals qualitatively identified the following 4 potential economic impacts for the NHS: decreasing adverse events, improving patient well-being, decreasing wait lists, and staff workload. We did not find evidence to suggest that the clinical condition was associated with digital consulting use. Conclusions Nurses and physiotherapists were the greatest users of digital consulting. Teams appear to use an efficient triage system with the most expensive members digitally consulting less than lower-paid team members. Staff report showed concerns regarding time spent digitally consulting, which implies that direct costs increase. There remain considerable gaps in evidence related to cost-effectiveness of digital consulting, but this study has highlighted important cost-related outcomes for assessment in future cost-effectiveness trials of digital consulting

Patients’ online access to their primary care electronic health records and linked online services: implications for research and practice

Online access to medical records and linked services, including requesting repeat prescriptions and booking appointments, enables patients to personalize their access to care. However, online access creates opportunities and challenges for both health professionals and their patients, in practices and in research. The challenges for practice are the impact of online services on workload and the quality and safety of health care. Health professionals are concerned about the impact on workload, especially from email or other online enquiry systems, as well as risks to privacy. Patients report how online access provides a convenient means through which to access their health provider and may offer greater satisfaction if they get a timely response from a clinician. Online access and services may also result in unforeseen consequences and may change the nature of the patient-clinician interaction. Research challenges include: (1) Ensuring privacy, including how to control inappropriate carer and guardian access to medical records; (2) Whether online access to records improves patient safety and health outcomes; (3) Whether record access increases disparities across social classes and between genders; and (4) Improving efficiency. The challenges for practice are: (1) How to incorporate online access into clinical workflow; (2) The need for a business model to fund the additional time taken. Creating a sustainable business model for a safe, private, informative, more equitable online service is needed if online access to records is to be provided outside of pay-for-service systems

Physician Satisfaction: The Role of E-mail Communication in the Practice of Medicine

Communication between a physician and a patient is an integral part to the healthcare delivery system. E-mail has the power to fully utilize a physician’s medical expertise for the good of the patient. However, many physicians do not offer this service to their patients in the United States. This study analyzes factors that impact e‐mail utilization among physicians and whether e-mail use contributes to career satisfaction of physicians using the 2008 Health Tracking and Physician Survey. Controlling for the effect of physician and practice characteristics, such as financial incentive for providing services, gender, specialty, practice type, and reliance on Medicaid revenue, this study suggests that qualities like specializing have a significant positive effect, while working in a solo practice has a negative effect on e-mail use by physicians. Financial incentives to expand medical services have a significant positive effect on e‐mail use. This study also suggests that e‐mail utilization has a positive effect on career satisfaction of physicians. Physicians preferred to spend more time e-mailing other physicians than their patients. Thus, to enhance coordination and outcomes, financial incentives should be put into place

Patient-To-Physician Messaging: Volume Nearly Tripled As More Patients Joined System, But Per Capita Rate Plateaued

Patients want to be able to communicate with their physicians by e-mail. However, physicians are often concerned about the impact that such communications will have on their time, productivity, and reimbursement. Typically, physicians are not reimbursed for time spent communicating with patients electronically. But under federal meaningful-use criteria for information technology, physicians can receive a modest incentive for such communications. Little is known about trends in secure e-mail messaging between physicians and patients. To understand these trends, we analyzed the volume of messages in a large academic health care system’s patient portal in the period 2001–10. At the end of 2010, 49,778 patients (22.7 percent of all patients seen within the system) had enrolled in the portal, and 36.9 percent of enrolled patients (8.4 percent of all patients) had sent at least one message to a physician. Physicians in the aggregate saw a near tripling of e-mail messages during the study period. However, the number of messages per hundred patients per month stabilized between 2005 and 2010, at an average of 18.9 messages. As physician reimbursement moves toward global payments, physicians’ and patients’ participation in secure messaging will likely increase, and electronic communication should be considered part of physicians’ job descriptions

Az orvos–beteg kommunikáció új lehetőségei – a betegek elvárásai alapján = Possibilities of doctor–patient communication – understanding patients’ expectations

Absztrakt: Bevezetés: Az orvos és betege közötti konzultáció napjainkban már nem korlátozódik a szóbeli, személyes találkozóra; számos új technikai lehetőség kínálkozik a kapcsolattartásra. Célkitűzés: Kutatásunk célja volt megvizsgálni, hogy két személyes konzultáció között milyen módon kommunikál egymással orvos és betege, valamint hogyan szeretnék a betegek szükség esetén orvosukat elérni. Módszer: Egy budapesti szakrendelőben várakozó potenciális betegek körében kérdőíves felmérést végeztünk, amely az alábbi kérdéscsoportokra épült: orvoshoz fordulási szokások, szakorvossal való kommunikáció módja, technikai eszközök használata és szociodemográfiai adatok. Statisztikai analízis: Egyszerű leíró jellegű elemzéseket, khi-négyzet-próbát és bináris logisztikus regressziót alkalmaztunk. Eredmények: A résztvevők (260 fő) 36,2%-a férfi, 63,8%-a nő volt. Minden negyedik betegre jellemző volt, hogy két személyes konzultáció között egyáltalán nem lépett kapcsolatba az orvosával. A többiek – tekintettel a különböző szociodemográfiai csoportokra, jelentősebb különbség nélkül – szükség esetén vonalas telefonon elérték az asszisztenst vagy közvetlenül orvosukat is; esetleg mobiltelefonon is. A betegek kétharmada több személyes konzultációt szeretne orvosával, fele szívesen írna e-mailt neki, harmada mobilon is hívná orvosát, ha lehetősége lenne rá. Több személyes konzultációt szeretnének dominánsan a férfiak, kisebb arányban az elváltak, az özvegyek, a szakmunkás-végzettségűek. Minden második beteg szívesen váltana e-mailt orvosával, főleg a fiatalok és a magasabb iskolai végzettségűek. Következtetés: A betegeknek az orvossal való szükséges konzultációra vonatkozó preferenciái szociodemográfiai csoportok szerint különböznek. Figyelembe véve eredményeinket, a feltételek megteremtésével a járóbeteg-rendelések hatékonyságát növelni lehetne. Orv Hetil. 2018; 159(50): 2136–2143. | Abstract: Introduction: Nowadays doctor–patient consultation is not limited to personal appointments, there are new technical possibilities to keep contact. Aim: The aim of our study was to examine the way in which the doctor and patient interact with each other between two personal consultations and how the patients would like to reach their physicians when needed. Method: Questionnaire survey was done among waiting patients in an outpatient clinic in Budapest. The questionnaire was based on the following groups of questions: habits of visiting a doctor, the methods of communication with a specialist, use of technical tools and socio-demographic data. Statistical analysis: Simple descriptive analysis, chi-square test and binary logistic regression were used. Results: The participants (260 persons) were in 36.2% male and in 63.8% female. One out of four patients did not contact the doctor between two personal consultations. The rest of the patients contacted the nurse by phone or their doctors on their mobile even as per different socio-demographic groups but without a significant difference in between those. Two thirds of the patients would like to have more face to face appointments with their doctor, half of them would like to keep contact by e-mail, and one out of three would call the doctor on mobile phone as far as possible. More men need personal consultations dominantly and in smaller proportion divorced, widowed and patients with vocational education. Half of the patients would like to e-mail their doctor, especially the younger and higher educated people. Conclusion: Patients’ consultation preferences differ by socio-demographic groups. Reestablishing conditions by taking all of our results into account, the efficiency of outpatient-clinics could be increased. Orv Hetil. 2018; 159(50): 2136–2143

Examining the Impact of Design Features of Electronic Health Records Patient Portals on the Usability and Information Communication for Shared Decision Making

The use of the Electronic Health Records (EHR) patient portal has been shown to be effective in generating positive outcomes in patients’ healthcare, improving patient engagement and patient-provider communication. Government legislation also required proof of its meaningful use among patients by healthcare providers. Typical patient portals also include features such as health information and patient education materials. However, little research has examined the specific use of patient portals related to individuals with specific diseases such as inflammatory bowel diseases (IBDs). IBDs are life-long, not curable, chronic diseases that can impact the whole population. Individuals with IBDs may have higher needs to acquire health information from their EHR portals to properly self-manage their health conditions. The research aims of the present dissertation are to understand the online health information-seeking behaviors of a target group (IBDs) of patients, the use of EHR patient portals, and the impact of design features of EHR patient portals on the usability and information communication for shared decision making. Through this dissertation, I conducted four studies to address the above research aims. First, I identified how individuals with inflammatory bowel disease (IBD) used the internet for health information seeking, the factors impacting their use of the internet to obtain health information, and how they used the internet for health-related tasks. The purpose of this study is to get a general understanding of the online health information-seeking behaviors and to guide the study of health information presentation of EHR portals in the following research. Second, I examined what factors influenced an EHR patient portal user to believe that the portal is a valuable part of their health care. This part of the dissertation aimed to reveal the critical design factors that help design an EHR portal perceived as valuable in managing health. Third, I looked at how patients used EHR patient portals, what features of the portals facilitated their use and encouraged Shared Decision Making (SDM) and engagement in health management and what features acted as barriers to SDM and their engagement in health management. This part of my dissertation focused on a broad understanding of EHR portals usage by introducing more specific factors such as features of EHR portals. Fourth, I conducted an eye-tracking study to examine how information presentation methods and chatbots impact the use and effect of patient portals. This part of my dissertation built on the other studies within my dissertation and deepened the understanding of the influence of different EHR portal designs on their effectiveness and people’s willingness to participate in SDM. The results of this dissertation contribute to the literature of understanding the information-seeking behaviors of IBD patients and the use of portals, as well as the design considerations of how to make a suitable EHR portal to support the information-seeking needs of IBD patients. The results of this dissertation can be used to guide building proper patient education materials to support their health information needs of their specific health condition, especially for individuals with chronic diseases that require a certain amount of self-management. Meanwhile, examining artificial intelligence (AI) based chatbots use in EHR portals reveals a potential path of AI use in healthcare, such as information acquisition and patient education. Designing good usable EHR may also facilitate the process of informing patients of the advantages and disadvantages of treatment plans for their disease and, therefore, may increase their willingness to participate in SDM

CELLPHONE, EMAIL, AND TEXT-MESSAGING AND PATIENT-PHYSICIAN COMMUNICATION IN PRIMARY CARE

Patient-provider communication is an important aspect of quality of care and poor communication is a frequent problem. Evolving communication technologies can create new problems as well as offer opportunities for addressing them. It is not known how providers choose among available technologies, decide who of their patients to communicate using such technology, or how use influences patient satisfaction. This thesis addresses these questions in three aims, incorporating a survey of primary care providers on their communication patterns, the linkage of survey results with existing patient-reported data, and qualitative interviews with primary care physicians on their experiences with favorite patients. In Aim 1, I found that while more providers had used their cellphones than email to communicate to patients (54% vs. 38%, p=0.03), they were more inclined to give their email addresses than cellphone numbers (56% vs. 37%, p<0.001). Academic providers and providers who gave patients their email addresses were more likely to communicate with their patients electronically than community providers and those who did not give email addresses, respectively. In Aim 2, multivariable regression analyses revealed that making email addresses available to patients by non-pediatric providers was associated with a 19-point difference in overall satisfaction but not individual satisfaction domains. The offering of a provider email address is a signifier of a strong patient-provider relationship. The use of cellphone, email, and text-messaging was not associated with satisfaction. In Aim 3, I found that favorite patients are often not like their physicians in socio-demographic and personality characteristics. Cellphone numbers were privileged by physicians and when given, only to a few patients whose illnesses warranted having direct access; email addresses were given more often, especially when the patient was a fellow physician or employee of the same medical institution. Some favorite patients fell into these categories; others did not. These findings suggest the need for institutional guidelines that establish expectations and boundaries in communicating with patients outside of the office

Communications in general practice and the domestication of ICT

The NHS is currently being transformed by the implementation of the National Programme for Information Technology (NPfIT). This thesis examines the use of Information Communications Technology (ICT) and its consequences for communications in general practice. While drawing on a range of social scientific approaches to ICT, this research explores the particular utility of the 'domestication' framework advanced by Silverstone and Sorensen. It considers how users in general practice 'tame' and use technology by incorporating its affordances into their work roles and communication practices.Drawing on previous survey work, this research adopts a comparative, ethnographic approach, analyzing patterns of talk and writing in two general practices in London. Empirical work involved analysis of local and national policy documentation and two ethnographic studies that were designed to identify changes in attitudes and behaviours across a defined set of actors over time. Interviews generated preliminary evidence as to how multiple users in general practice communicated by a variety of means, including the problems/concerns they encountered or created in doing so. Observation was used to gather further direct evidence of those problems as they were negotiated and resolved.Although the two cases were both of practices that had been identified in an earlier survey as 'paper-light' which might therefore have been assumed to make effective use of ICT, usage was uneven and sharp differences were noted in the way in which broadly similar technologies were domesticated by specific user groups. Analysis of these differences produced three key findings. Firstly, domestication of ICT in general practice is difficult. To be successfully domesticated, ICTs have to be locally negotiated both horizontally and vertically in order to connect with working practices of the individual users. Secondly, the struggle to 'tame' ICTs is shaped by the extent to which different groups of users perceive ICT as assisting or compromising their roles and responsibilities. This, in turn, increases the diversity between user groups. Thirdly, the research indicated the importance of local context and workplace cultures which facilitate or inhibit the negotiations or 'communications about communications' required to domesticate ICTs.A concluding discussion reflects on the changing relationship between ICTs and communications in general practice and, in particular, the impact of ICT on faceto-face communications. The key contribution of the study lies in offering a theoretically-sophisticated framework in which to examine and explicate detailed patterns of communications in general practice. By addressing both electronic and paper-based communication as well as face-to-face interaction, it provides a basis for future research in this area as NPfIT develops

The diffusion of the internet amongst South African primary care doctors : an activity systems view

Includes abstract. Includes bibliographical references (p. 379-436). Has accompanying material on CD