Original Research

Journal of General Internal Medicine

, Volume 28, Issue 7, pp 914-920

Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net

  • Adam SchickedanzAffiliated withDepartment of Pediatrics, University of California San Francisco Email author 
  • , David HuangAffiliated withDepartment of Internal Medicine, University of California San Francisco
  • , Andrea LopezAffiliated withCenter for Vulnerable Populations at San Francisco General Hospital, Department of Internal Medicine, University of California San Francisco
  • , Edna CheungAffiliated withUniversity of California at Berkeley
  • , C. R. LylesAffiliated withCenter for Vulnerable Populations at San Francisco General Hospital, Department of Internal Medicine, University of California San Francisco
  • , Tom BodenheimerAffiliated withDepartment of Family and Community Medicine, University of California San Francisco
  • , Urmimala SarkarAffiliated withCenter for Vulnerable Populations at San Francisco General Hospital, Department of Internal Medicine, University of California San Francisco

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ABSTRACT

BACKGROUND

Electronic and internet-based tools for patient–provider communication are becoming the standard of care, but disparities exist in their adoption among patients. The reasons for these disparities are unclear, and few studies have looked at the potential communication technologies have to benefit vulnerable patient populations.

OBJECTIVE

To characterize access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network.

DESIGN

Observational, cross-sectional study

PARTICIPANTS

Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH)

MAIN MEASURES

Current email use, interest in communicating electronically with health care professionals, barriers to and facilitators of electronic health-related communication, and demographic data—all self-reported via survey.

KEY RESULTS

Sixty percent of patients used email, 71 % were interested in using electronic communication with health care providers, and 19 % reported currently using email informally with these providers for health care. Those already using any email were more likely to express interest in using it for health matters. Most patients agreed electronic communication would improve clinic efficiency and overall communication with clinicians.

CONCLUSIONS

A significant majority of safety net patients currently use email, text messaging, and the internet, and they expressed an interest in using these tools for electronic communication with their medical providers. This interest is currently unmet within safety net clinics that do not offer a patient portal or secure messaging. Tools such as email encounters and electronic patient portals should be implemented and supported to a greater extent in resource-poor settings, but this will require tailoring these tools to patients’ language, literacy level, and experience with communication technology.

KEY WORDS

health information technology disparities clinical communication electronic patient portal