Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
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.
Observational, cross-sectional study
Adult patients (≥ 18 years) in six resource-limited community clinics in the San Francisco Department of Public Health (SFDPH)
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.
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.
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.
- Fox S. The Social Life of Health Information, 2011. Washington, DC: Pew Research Center; 2011.
- Liederman EM, Lee JC, Baquero VH. The impact of patient–physician web messaging on provider productivity. Management. 2005;19(2):81–86.
- Delbanco T, Sands DZ. Electrons in flight-e-mail between doctors and patients. The New Engl J Med. 2004;350(17):1705-7. Available at: http://www.ncbi.nlm.nih.gov/pubmed/15102994, accessed July, 2012.
- Ralston JD, Rutter CM, Carrell D, et al. Patient use of secure electronic messaging within a shared medical record: a cross-sectional study. J Gen Intern Med. 2009;24(3):349-55. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2642567&tool=pmcentrez&rendertype=abstract, accessed July 2012.
- Zhou YY, Kanter MH, Wang JJ, Garrido T. Improved quality at Kaiser Permanente through e-mail between physicians and patients. Health Affairs (Project Hope). 2010;29(7):1370-5. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20606190, accessed July, 2012.
- Rosen P, Kwoh CK. Patient–physician e-mail: an opportunity to transform pediatric health care delivery. Pediatrics. 2007;120(4):701-6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/17908755, accessed July 2012.
- Ralston JD, Hirsch IB, Hoath J, Mullen M, Cheadle A. Web-based collaborative care for type 2 diabetes. Diabetes Care. 2009;32(2):234–239. CrossRef
- Harris LT, Haneuse SJ, Martin DP. Diabetes quality of care and outpatient utilization with electronic patient–provider messaging. Diabetes Care. 2009;32(7):1–5. CrossRef
- Anon. Department of Health and Human Health Information Technology: initial set of standards, implementation specifications, and certification criteria for electronic health record technology; Federal Register. 2010:1-66.
- Anon. Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA). 2009.
- Lenhart A, Rainie L, Fox S, et al. Who’ s Not Online. Washington DC: Pew Research Center; 2000.
- Roblin DW, Houston TK, Allison JJ, Joski PJ, Becker ER. Disparities in use of a personal health record in a managed care organization. Journal of the American Medical Informatics Association: JAMIA. 2009;16(5):683-9. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2744719&tool=pmcentrez&rendertype=abstract, accessed July 2012.
- Ancker JS, Barrón Y, Rockoff ML, et al. Use of an electronic patient portal among disadvantaged populations. J Gen Intern Med. 2011;26(10):1117-23. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21647748, accessed July 2012.
- Yamin CK, Emani S, Williams DH, et al. The digital divide in adoption and use of a personal health record. Arch Intern Med. 2011;171(6):568-74. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21444848, accessed July 2012.
- Sarkar U, Karter AJ, Liu JY, et al. Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access. J Am Med Inf Assoc: JAMIA. 2011;18(3):318-21. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3078675&tool=pmcentrez&rendertype=abstract, accessed July 2012.
- Carroll AE, Rivara FP, Ebel B, Zimmerman FJ, Christakis DA. Household computer and Internet access: the digital divide in a pediatric clinic population The Regenstrief Institute for Health Care , Indianapolis , IN. Symposium A Q J Mod Foreign Lit. 2005:111-115.
- Sarkar U, Karter AJ, Liu JY, et al. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). J Health Commun. 2010;15 Suppl 2(922973516):183-96. Available at: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=3014858&tool=pmcentrez&rendertype=abstract, accessed July 2012.
- Goel MS, Brown TL, Williams A, et al. Disparities in enrollment and use of an electronic patient portal. J Gen Intern Med. 2011;26(10):1112-6. Available at: http://www.ncbi.nlm.nih.gov/pubmed/21538166, accessed July 2012.
- Lyles C, Harris L, Jordan L, et al. Patient race/ethnicity and shared medical record use among diabetes patients. Medical Care. 2012;50(5):434–440. CrossRef
- Jha AK, DesRoches CM, Shields AE, et al. Evidence of an emerging digital divide among hospitals that care for the poor. Health Affairs (Project Hope). 2009;28(6):w1160-70. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19858142, accessed July 2012.
- Chang BL, Bakken S, Brown SS, et al. Bridging the digital divide: reaching vulnerable populations. J Am Med Inform Assoc. 2004;11(6):448. Available at: http://jamia.bmj.com/content/11/6/448.short, accessed July 2012.
- Hsu J, Huang J, Kinsman J, et al. Use of e-Health services between 1999 and 2002: a growing digital divide. J Am Med Inform Assoc. 2005;12(2):164. Available at: http://18.104.22.168/content/12/2/164.abstract, accessed July 2012.
- Zickuhr K, Smith A. Digital Differences. Washington, DC: Pew Internet and American Life Project; 2012.
- Lobach DF, Willis JM, Macri JM, Simo J, Anstrom KJ. Perceptions of Medicaid beneficiaries regarding the usefulness of accessing personal health information and services through a patient Internet portal. AMIA Annual Symposium Proceedings 2006:509-13
- Optum Institute. Meaningful Consumer Engagement: A Survey of Stakeholder Views. http://institute.optum.com/technologies/∼/media/OptumInstitute/Page_Elements/Articles/Institute_HealthIT_FINAL.pdf, accessed July 2012.
- Andrea H, James W, David K, Kim R, David Y, Steven P, Deborah D, Kuck Sarah OE. Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. J Am Med Inform Assoc. 2004;11(6):505–514. CrossRef
- Quinn CC, Clough SS, Minor JM, Lender D, Okafor MC, Gruber-Baldini A. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Diabetes Technol Ther. 2008;10(3):160–168. CrossRef
- Fischer HH, Moore SL, Ginosar D, Davidson AJ, Rice-Peterson CM, Durfee MJ, et al. Care by cell phone: text messaging for chronic disease management. Am J Manag Care. 2012;18(2):e42–e47.
- Prestigiacomo J. Secure messaging via the cloud and mobile devices: data security issues emerge with new technologies. Health Inf. 2011;28(5):24–29.
- Gibbons M, Casale C. Reducing disparities in health care quality: the role of health IT in underresourced settings. Med Care Res Rev. 2010;67(5):155S–162S. CrossRef
- Gibbons M, Fleisher L, Slamon R, et al. Exploring the potential of Web 2.0 to address health disparities. J Heal Commun. 2011;16:77–89. CrossRef
- Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net
Journal of General Internal Medicine
Volume 28, Issue 7 , pp 914-920
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- health information technology
- clinical communication
- electronic patient portal
- Industry Sectors
- Author Affiliations
- 1. Department of Pediatrics, University of California San Francisco, 505 Parnassus Avenue, M691, San Francisco, CA, 94143, USA
- 2. Department of Internal Medicine, University of California San Francisco, San Francisco, USA
- 3. Center for Vulnerable Populations at San Francisco General Hospital, Department of Internal Medicine, University of California San Francisco, San Francisco, USA
- 4. University of California at Berkeley, Berkeley, USA
- 5. Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA