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



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.

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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.


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.

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

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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).

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