E-mail Communications in Family Practice What Do Patients Expect?

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Original Research

E-mail Communications in Family Practice What Do Patients Expect?

J Fam Pract. 2001 May;50(5):414-418

References

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Although it has been reported that consumers are 35% more likely to choose a physician who offers to communicate with patients using E-mail,¹⁷ this is not a marketing strategy that physicians should take lightly. From our study, one could assume that patients have very high expectations regarding response times for this form of provider-patient communication. One of the more disconcerting findings of our study was the exceptionally rapid turnaround time patients expected for obtaining laboratory results or test reports, prescription refills, and answers to their medical questions. Knowing that patients would expect these results within 24 hours at least 70% of the time may be unsettling to many physicians who would feel that this time frame is not attainable with the current system of laboratory processing and handling patient requests. Meeting those expectations may require major changes for physician practices.

The Health Institution Portability and Accountability Act of 1996 places comprehensive new security requirements on the US health care industry.^19,20 The standards for privacy and protection of all health information that can be linked directly to an individual mandate that all patient E-mail communication be as secure as possible. Physicians using E-mail with their patients must be familiar and be compliant with these federal regulations.* The Journal of the American Medical Informatics Association also recently published “guidelines for the clinical use of electronic mail with patients.”¹⁴ This is an excellent reference for any physician considering E-mail communication and is available at their Web site (www.amia.org).

Limitations

Our study has several limitations. The surveys involved patients who were being seen in 6 clinics in central Texas; therefore, this sample may not truly represent the population at large. Also, all patients were scheduled to see family physicians, limiting the ability to generalize our findings to other disciplines. Future studies should expand beyond one discipline to include other primary care and specialty care departments. Also, the survey results reflect patients’ self-reported anticipated behavior if services were available and do not reflect actual usage. Another limitation is the small number of racial/ethnic minority groups.

The survey instrument we used lacked specificity on some questions. For example, we do not know whether patient expectations vary by test (ie, Do patients expect a faster response to a blood test than to an x-ray or a Papanicolaou test?) Future studies should use more specific survey instruments. Our study did not include an assessment of urban versus rural differences in E-mail communication, although it would seem that factors such as access, time, and lack of knowledge about this new technology may make a difference.²¹ Additionally, many previous studies have unveiled disparities in health care access between urban and rural populations, defined as places with fewer than 2500 residents. For example, the 25% of Americans who live in rural areas are less likely to use preventive screening services and wear seat belts. Also, in 1996, 20% of the rural population was uninsured, compared with 16% of the urban population.²² Future studies should incorporate this variable in the data collection process.

Conclusions

In central Texas the majority of patients attending⁶ family practice clinics reported having access to E-mail and indicated they would use it to request prescription refills, obtain routine laboratory results or test reports, and for nonurgent consultations independent of their age group, sex, education, or income. Also, there was a wide variability of E-mail access from practice to practice. Independent of sex or race, patients have high expectations that these tasks can be completed in a relatively short time.

Acknowledgments

We wish to acknowledge the contributions made by all the family physicians, operations managers, and supervisors at the 6 participating clinics during the data collection. We are also grateful to Pat Kirkpatrick for her initial ideas, Saundra Mason for data management, and Marcine Chambers, Linda Teer, and Virginia Gray for secretarial support.

Related resources

American Medical Informatics Association—nonprofit organization of individuals, institutions and corporations dedicated to developing and using information technologies to improve health care. http://www.amia.org
California Academy Of Family Physicians—offers monograph on “Making the Most of Physician-Patient E-mail.” http://www.familydocs.org