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

Journal of General Internal Medicine volume 28, pages 914–920 (2013)Cite this article

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.

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REFERENCES

  1. Fox S. The Social Life of Health Information, 2011. Washington, DC: Pew Research Center; 2011.

    Google Scholar 

  2. Liederman EM, Lee JC, Baquero VH. The impact of patient–physician web messaging on provider productivity. Management. 2005;19(2):81–86.

    Google Scholar 

  3. 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.

  4. 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.

  5. 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.

  6. 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.

    Google Scholar 

  7. 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.

    PubMed  Article  Google Scholar 

  8. 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.

    Article  Google Scholar 

  9. 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.

  10. 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.

  11. Lenhart A, Rainie L, Fox S, et al. Who’ s Not Online. Washington DC: Pew Research Center; 2000.

    Google Scholar 

  12. 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.

  13. 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.

  14. 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.

  15. 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.

    Google Scholar 

  16. 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.

  17. 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.

  18. 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.

    Google Scholar 

  19. 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.

    PubMed  Article  Google Scholar 

  20. 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.

  21. 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.

  22. 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://171.67.114.118/content/12/2/164.abstract, accessed July 2012.

  23. Zickuhr K, Smith A. Digital Differences. Washington, DC: Pew Internet and American Life Project; 2012.

    Google Scholar 

  24. 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

  25. 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.

  26. 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.

    Article  Google Scholar 

  27. 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.

    PubMed  Article  Google Scholar 

  28. 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.

    PubMed  Google Scholar 

  29. Prestigiacomo J. Secure messaging via the cloud and mobile devices: data security issues emerge with new technologies. Health Inf. 2011;28(5):24–29.

    Google Scholar 

  30. 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.

    PubMed  Article  Google Scholar 

  31. 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.

    Article  Google Scholar 

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Acknowledgements

Contributors

We thank Dr. Alicia Fernandez for her comments on the survey tool, as well as Drs. Mark Ghaly, Hali Hammer, Shannon Thyne, Lisa Golden, Albert Yu, Alice Chen, and Catherine James for their clinics’ participation in the study.

Funders

Adam Schickedanz was supported by The University of California San Francisco Clinical and Translational Science Institute. Urmimala Sarkar was supported by AHRQ K08 HS017594. The funding sources had no role in the study design, data collection, data analysis, manuscript preparation, or decision to submit for publication.

Prior Presentations

Earlier results were presented at the Society of General Internal Medicine’s annual conference in May of 2012 and the AcademyHealth annual research meeting in June of 2012.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Pediatrics, University of California San Francisco, 505 Parnassus Avenue, M691, San Francisco, CA, 94143, USA

    Adam Schickedanz MD

  2. Department of Internal Medicine, University of California San Francisco, San Francisco, USA

    David Huang MD

  3. Center for Vulnerable Populations at San Francisco General Hospital, Department of Internal Medicine, University of California San Francisco, San Francisco, USA

    Andrea Lopez BS, C. R. Lyles PhD & Urmimala Sarkar MD, MPH

  4. University of California at Berkeley, Berkeley, USA

    Edna Cheung BA

  5. Department of Family and Community Medicine, University of California San Francisco, San Francisco, USA

    Tom Bodenheimer MD, MPH

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  1. Adam Schickedanz MD
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  2. David Huang MD
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  3. Andrea Lopez BS
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  4. Edna Cheung BA
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  5. C. R. Lyles PhD
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  6. Tom Bodenheimer MD, MPH
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  7. Urmimala Sarkar MD, MPH
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Correspondence to Adam Schickedanz MD.

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Schickedanz, A., Huang, D., Lopez, A. et al. Access, Interest, and Attitudes Toward Electronic Communication for Health Care Among Patients in the Medical Safety Net. J GEN INTERN MED 28, 914–920 (2013). https://doi.org/10.1007/s11606-012-2329-5

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  • DOI: https://doi.org/10.1007/s11606-012-2329-5

KEY WORDS

  • health information technology
  • disparities
  • clinical communication
  • electronic patient portal