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Bajwa NM, Perron NJ, Braillard O, Achab S, Hudelson P, Dao MD, Lüchinger R, Mazouri-Karker S. Has telemedicine come to fruition? Parents' and pediatricians' perceptions and preferences regarding telemedicine. Pediatr Res 2024:10.1038/s41390-024-03172-w. [PMID: 38555380 DOI: 10.1038/s41390-024-03172-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 02/27/2024] [Accepted: 03/13/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Telemedicine has increasingly become a viable option for patient care and may increase access to care. The aim of our study was to evaluate both parent and pediatrician perceptions, preferences, and acceptability regarding the use of different telemedicine modalities. METHODS We conducted a cross-sectional survey of both parents and pediatricians in Geneva, Switzerland in 2021. The questionnaire focused on digital literacy, preferences, acceptability, advantages, and disadvantages regarding telemedicine (phone, email, video, and instant message). Descriptive statistics and comparisons of preferences and perceptions (Pearson Chi2 and logistic regression) were performed. RESULTS Two hundred and twenty-two parents and 45 pediatricians participated. After face-to-face consultations, parents and pediatricians preferred the phone for simple medical advice, discussion of parameters, acute or chronic problems, and psychological support. Email was preferred for communication of results and prescription renewal. Main reasons for using telemedicine were avoiding travel and saving time. Disadvantages were lack of physical examination, technical problems, and unsuitability of the reason for consultation. CONCLUSIONS Understanding the factors that influence acceptance and satisfaction with telemedicine is vital for its successful implementation. Convenience, quality of care, trust, strong pediatrician-parent relationships, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping parent and pediatrician attitudes toward telemedicine. IMPACT The COVID-19 pandemic spurred the expansion of the use of telemedicine in pediatric care. Few studies have addressed parent and pediatrician perceptions and preferences regarding telemedicine. Both parents and pediatricians consider certain telemedicine modalities (phone, email, video, and instant message) pertinent in only specific clinical situations. Advantages of telemedicine outweigh disadvantages with parents and pediatricians appreciating the increased access to care, time savings, and avoiding transport. However, the lack of a physical examination remains a significant disadvantage. Convenience, quality of care, trust, strong pediatrician-parent relationship, technical reliability, user-friendliness, and privacy considerations play significant roles in shaping attitudes towards telemedicine.
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Affiliation(s)
- Nadia M Bajwa
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland.
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directorate, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Primary Care Division, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
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Mazouri-Karker S, Lüchinger R, Braillard O, Bajwa N, Achab S, Hudelson P, Dominicé Dao M, Junod Perron N. Perceptions of and Preferences for Telemedicine Use Since the Early Stages of the COVID-19 Pandemic: Cross-Sectional Survey of Patients and Physicians. JMIR Hum Factors 2023; 10:e50740. [PMID: 37934574 PMCID: PMC10664018 DOI: 10.2196/50740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/12/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND While the use of telemedicine (TLM) increased worldwide during the early phases of the COVID-19 pandemic, little is known about the use and acceptance of TLM post the COVID-19 pandemic. OBJECTIVE This study aims to evaluate patients' and physicians' self-reported use, preferences, and acceptability of different types of TLM after the initial phases of the COVID-19 pandemic. METHODS We conducted a cross-sectional survey among patients and physicians in Geneva, Switzerland, between September 2021 and January 2022. Patients in waiting rooms of both private and public medical centers and emergency services were invited to answer a web-based questionnaire. Physicians working in private and public settings were invited by email to answer a similar questionnaire. The questionnaires assessed participants' sociodemographics and digital literacy; self-reported use of TLM; as well as preferences and acceptability of TLM for different clinical situations. RESULTS A total of 567 patients (309/567, 55% women) and 448 physicians (230/448, 51% women and 225/448, 50% in private practice) responded to the questionnaire. Patients (263/567, 46.5%) and physicians (247/448, 55.2%) generally preferred the phone over other TLM formats and considered it to be acceptable for most medical situations. Email (417/567, 73.6% and 308/448, 68.8%) was acceptable for communicating exam results, and medical certificates (327/567, 67.7% and 297/448, 66.2%) and video (302/567, 53.2% and 288/448, 64.3%) was considered acceptable for psychological support by patients and physicians, respectively. Older age was associated with lower acceptability of video for both patients and physicians (odds ratio [OR] 0.03, 95% CI 0.00-0.33 and OR 0.23, 95% CI 0.08-0.66) while previous use of video was positively associated with video acceptability (OR 3.16, 95% CI 1.84-5.43 and OR 3.34, 95% CI 2.91-5.54). Psychiatrists and hospital physicians were more likely to consider video to be acceptable (OR 10.79, 95% CI 3.96-29.30 and OR 3.97, 95% CI 2.23-7.60). CONCLUSIONS Despite the development of video, the acceptability of video remains lower than that of the phone for most health issues or patient requests. There is a need to better define for which patients and in which medical situations video can become safe and efficient.
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Affiliation(s)
- Sanae Mazouri-Karker
- E-health and Telemedicine Division, Geneva University Hospitals, Geneva, Switzerland
| | - Robin Lüchinger
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Olivia Braillard
- Primary Care Division, Geneva University Hospitals, Geneva, Switzerland
| | - Nadia Bajwa
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of General Pediatrics at the Children's Hospital, Geneva University Hospitals, Geneva, Switzerland
| | - Sophia Achab
- Treatment Centre ReConnecte, Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
- Clinical and Sociological Research Unit, WHO Collaborating Centre for Training and Research in Mental Health, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Melissa Dominicé Dao
- Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Noelle Junod Perron
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Medical Directory, Geneva University Hospitals, Geneva, Switzerland
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Roscoe RD, Balyan R, McNamara DS, Banawan M, Schillinger D. Automated Strategy Feedback Can Improve the Readability of Physicians' Electronic Communications to Simulated Patients. INTERNATIONAL JOURNAL OF HUMAN-COMPUTER STUDIES 2023; 176:103059. [PMID: 37193118 PMCID: PMC10174593 DOI: 10.1016/j.ijhcs.2023.103059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Modern communication between health care professionals and patients increasingly relies upon secure messages (SMs) exchanged through an electronic patient portal. Despite the convenience of secure messaging, challenges include gaps between physician and patient expertise along with the asynchronous nature of such communication. Importantly, less readable SMs from physicians (e.g., too complicated) may result in patient confusion, non-adherence, and ultimately poorer health outcomes. The current simulation trial synthesizes work on patient-physician electronic communication, message readability assessments, and feedback to explore the potential for automated strategy feedback to improve the readability of physicians' SMs to patients. Within a simulated secure messaging portal featuring multiple simulated patient scenarios, computational algorithms assessed the complexity of SMs written by 67 participating physicians to patients. The messaging portal provided strategy feedback for how physician responses might be improved (e.g., adding details and information to reduce complexity). Analyses of changes in SM complexity revealed that automated strategy feedback indeed helped physicians compose and refine more readable messages. Although the effects for any individual SM were slight, the cumulative effects within and across patient scenarios showed trends of decreasing complexity. Physicians appeared to learn how to craft more readable SMs via interactions with the feedback system. Implications for secure messaging systems and physician training are discussed, along with considerations for further investigation of broader physician populations and effects on patient experience.
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Affiliation(s)
- Rod D Roscoe
- Arizona State University 7271 E. Sonoran Arroyo Mall Santa Catalina Hall 150 Mesa, AZ 85212 USA
| | - Renu Balyan
- State University of New York at Old Westbury PO Box 210, Old Westbury, NY 11568 USA
| | | | - Michelle Banawan
- Asian Institute of Management 123 Paseo de Roxas Avenue Makati, Metro Manila 1229, Philippines
| | - Dean Schillinger
- School of Medicine, Division of General Internal Medicine University of California, San Francisco 500 Parnassus Avenue San Francisco, CA 94143 USA
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Assing Hvidt E, Grønning A, Nisbeth Brøgger M, Møller JE, Fage-Butler A. Multilevel structures and human agency in relation to email consultations: A strong structuration theory analysis of the Danish general practice setting. Soc Sci Med 2021; 282:114155. [PMID: 34174578 DOI: 10.1016/j.socscimed.2021.114155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 06/03/2021] [Accepted: 06/15/2021] [Indexed: 01/10/2023]
Abstract
In recent years and throughout the developed world, policymakers have encouraged the implementation of digital patient-clinician interaction. Our focus is on the Danish general practice setting where email consultations were implemented as a mandatory service in 2009 and now constitute 21% of all consultations in general practice. Drawing upon strong structuration theory (SST), our analysis sets out to explore how email consultations are represented in structures on macro, meso and micro-levels and how the interplay between structures and agents plays out with respect to possible alignments, tensions and adjustments. We analyze data from policy documents on the macro and meso-levels, data from clinics' websites (meso-level) and data from interviews with GPs and patients (micro-level) (n = 53). Our findings show that the introduction of email consultation as a new health technology is a key site for development in email consultation practice, professional boundary setting and adjustments within the doctor-patient relationship. Our findings thus demonstrate that email consultation can be considered a dynamic component of a socio-technical network rather than a static medium for simple health transactions or information delivery. Based on these findings, we recommend that, for future implementation of patient-clinician digital communication it is important to investigate the multiple sources of influence on telecare practices and to see its intended users as agents who actively shape their own care motivated by opinions, relationships and values.
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Affiliation(s)
- Elisabeth Assing Hvidt
- Department of Public Health, Research Unit of General Practice, University of Southern Denmark, J.B. Winsløws Vej 9A, 5000, Odense C, Denmark; Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Matilde Nisbeth Brøgger
- School of Communication and Culture, Aarhus University, Jens Chr. Skous Vej 4, 8000, Aarhus C, Denmark.
| | - Jane Ege Møller
- Department of Clinical Medicine, Aarhus University, Palle Juul Jensens Boulevard 82, 8200, Aarhus N, Denmark.
| | - Antoinette Fage-Butler
- School of Communication and Culture, Aarhus University, Jens Chr. Skous Vej 4, 8000, Aarhus C, Denmark.
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Heisey‐Grove D, Rathert C, McClelland LE, Jackson K, DeShazo J. Classification of patient- and clinician-generated secure messages using a theory-based taxonomy. Health Sci Rep 2021; 4:e295. [PMID: 34084944 PMCID: PMC8142627 DOI: 10.1002/hsr2.295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND As secure electronic message exchange increases between patients and clinicians, we must explore and understand how patients and clinicians use those messages to communicate between clinical visits. OBJECTIVE To present the application of a taxonomy developed specifically to code secure message content in a way that allows for identification of patient and clinician communication functions demonstrated to be associated with patients' intermediate and health outcomes. METHOD We randomly sampled 1031 patients who sent and received 18 309 messages and coded those messages with codes from our taxonomy. We present the prevalence of each taxon (ie, code) within the sample. RESULTS The most common taxon among initial patient-generated messages were Information seeking (29.09%), followed by Scheduling requests (27.91%), and Prescription requests (23.09%). Over half of subsequent patient-generated messages included responses to clinic staffs' questions (58.31%). Six in 10 clinic staff responses included some form of Information sharing with process-based responses being most common (32.81%). A third of all clinician-generated messages (36.28%) included acknowledgement or some level of fulfilment of a patient's task-oriented request. Clinic staff sought information from patients in 20.54% of their messages. CONCLUSION This taxonomy is the first step toward examining whether secure messaging communication can be associated with patients' health outcomes. Knowing which content is positively associated with outcomes can support training of, and targeted responses from, clinicians with the goal of generating message content designed to improve outcomes. PATIENT CONTRIBUTION This study is based on analyses of patient-initiated secure message threads.
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Affiliation(s)
- Dawn Heisey‐Grove
- Promoting Health and Disease Prevention Department, Public Health Division, The Health FFRDCThe MITRE CorporationMcLeanVirginia
| | - Cheryl Rathert
- Health Administration DepartmentCollege of Health Professions, Virginia Commonwealth UniversityRichmondVirginia
| | - Laura E McClelland
- Department of Health Management and PolicySaint Louis UniversitySt. LouisMissouri
| | - Kevin Jackson
- Allied Health DepartmentNorfolk State UniversityNorfolkVirginia
| | - Jonathan DeShazo
- Department of Health Management and PolicySaint Louis UniversitySt. LouisMissouri
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Abstract
Abstract
NEW TECHNOLOGIES HAVE FACILITATED DOCTOR–PATIENT EMAIL CONSULTATIONS (E-CONSULTATIONS). GUIDELINES FOR E-CONSULTATION USE IN DENMARK STATE THAT THEY SHOULD BE USED FOR SIMPLE, CONCRETE AND NON-URGENT QUERIES; HOWEVER, A SMALL-SCALE DANISH STUDY SUGGESTED THAT DOCTORS ENCOUNTER E-CONSULTATIONS THAT DO NOT MATCH THE GUIDELINES. THE PURPOSE OF THIS ARTICLE IS TO EXPLORE WHETHER E-CONSULTATIONS IN DENMARK REFLECT RECOMMENDATIONS THAT THEY SHOULD BE SIMPLE, SHORT, CONCRETE AND WELL DEFINED, AND IF NOT, WHAT FORMS OF COMPLEXITY ARE EVIDENT. WE INDUCTIVELY ANALYSED 1,671 E-CONSULTATIONS FROM 38 PATIENTS AGED 21–91 YEARS COMMUNICATING WITH 28 DOCTORS, 6 NURSES, 1 MEDICAL STUDENT AND 8 SECRETARIES. RESULTS SHOWED BOTH QUANTITATIVE COMPLEXITY IN TERMS OF NUMBER OF INTERACTION TURNS, COMMUNICATIVE PARTICIPANTS, AND QUESTIONS ASKED, AND QUALITATIVE COMPLEXITY RELATING TO PATIENTS’ PSYCHOSOCIAL CONTEXTS AND GPS’ BIOMEDICAL DISEASE PERSPECTIVE. THUS, DESPITE EXISTING GUIDELINES AND THE LEANNESS ASSOCIATED WITH THE EMAIL MEDIUM, MULTIPLE FORMS OF COMPLEXITY WERE EVIDENT. THIS MISMATCH HIGHLIGHTS THE NEED FOR THEORETICAL DEVELOPMENT AS WELL AS THE VALUE OF RE-EXAMINING EXISTING POLICIES AND GUIDELINES REGARDING EXPECTATIONS FOR E-CONSULTATION USE.
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Affiliation(s)
- Minal Bakhai
- NHS England and NHS Improvement London, Skipton House, London SE1 6LH, UK
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8
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Casillas A, Perez-Aguilar G, Abhat A, Gutierrez G, Olmos-Ochoa TT, Mendez C, Mahajan A, Brown A, Moreno G. Su salud a la mano (your health at hand): patient perceptions about a bilingual patient portal in the Los Angeles safety net. J Am Med Inform Assoc 2021; 26:1525-1535. [PMID: 31373362 DOI: 10.1093/jamia/ocz115] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/18/2019] [Accepted: 06/13/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Driven by beneficial patient-centered outcomes associated with patient portal use and the Affordable Care Act, portal implementation has expanded into safety nets-health systems that offer access to care to a large share of uninsured, Medicaid, and other vulnerable populations. However, little attention has been paid to the factors that affect portal accessibility by the vulnerable patients served by these health systems-including those who are limited English proficient (LEP). MATERIALS AND METHODS The Los Angeles County Department of Health Services (LAC DHS), the second-largest safety net system in the nation, launched its first patient portal, and one of the few bilingual English-Spanish interfaces in existence, in March of 2015. To explore portal awareness and perceptions, we conducted focus groups with LAC DHS patients, in English and Spanish (LEP). The Technology Acceptance Model was used to guide thematic analysis of focus group data. RESULTS Of the 46 participants, 37 were patients and 9 were caretakers; 23 were English-speaking and 23 Spanish-speaking LEP. All patients had diabetes or hypertension. Over half had an annual household income <$10 000, yet 78% of English-speaking and 65% of Spanish-speaking LEP participants reported at-home Internet access. Participants' discussion centered around 3 major thematic narratives: (1) participants' awareness or attitudes about the LAC DHS portal; (2) role of culture, language, or community with regard to portal accessibility and utility; and (3) perceived needs for successful portal implementation. CONCLUSIONS Safety net participants identified concrete benefits to the portal and emphasized the need for portal engagement that offered accessible education, support, and resources in clinical and community settings. The portal offers an additional opportunity to engage the patient and family with trusted and validated health information, and should be further developed in this capacity. This study provides a better understanding of preferred improvements of patient portal engagement that guide broader health technology efforts to address electronic health disparities.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Giselle Perez-Aguilar
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Anshu Abhat
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Griselda Gutierrez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | | | - Carmen Mendez
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Anish Mahajan
- Department of Health Services, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Alpert JM, Markham MJ, Bjarnadottir RI, Bylund CL. Twenty-first Century Bedside Manner: Exploring Patient-Centered Communication in Secure Messaging with Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:16-24. [PMID: 31342283 DOI: 10.1007/s13187-019-01592-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient-centered communication (PCC) is integral to providing high-quality health care and is recommended to be incorporated during face-to-face consultations. Electronic communication, such as the use of secure messaging (SM) within patient portals, is a popular form of patient-provider communication, but preliminary studies have shown that PCC is rarely utilized by providers in SM. As a consequence, the patient-provider relationship can be negatively affected, especially for cancer patients who have greater electronic health information needs than the general population. Therefore, our objective was to determine the importance of SM to cancer patients and to identify which attributes of PCC are preferred to be incorporated into secure messages. Five focus groups were conducted, comprised of patients with a current or previous cancer diagnosis (three all-female; two all-male). Participants recalled their own experiences and reviewed simulated messages. Three main topics emerged from the thematic analysis: (1) the normalization of SM, (2) SM quality can affect perceptions of care, and (3) patients need guidance. Overall, participants valued the ability to communicate with their care team using SM and indicated that electronic communication may have the potential to have just as big of an impact on a patient's care than in-person communication.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, University of Florida, 2093 Weimer Hall, Gainesville, FL, 32611, USA.
| | - Merry Jennifer Markham
- Department of Medicine, Division of Hematology & Oncology, University of Florida, Gainesville, FL, USA
| | | | - Carma L Bylund
- College of Journalism and Communications / College of Medicine, University of Florida, Gainesville, FL, USA
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Atherton H, Boylan AM, Eccles A, Fleming J, Goyder CR, Morris RL. Email Consultations Between Patients and Doctors in Primary Care: Content Analysis. J Med Internet Res 2020; 22:e18218. [PMID: 33164902 PMCID: PMC7683246 DOI: 10.2196/18218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/31/2020] [Accepted: 09/14/2020] [Indexed: 11/18/2022] Open
Abstract
Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.
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Affiliation(s)
- Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Anne-Marie Boylan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Abi Eccles
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Joanna Fleming
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Clare R Goyder
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Rebecca L Morris
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, United Kingdom
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Casillas A, Abhat A, Mahajan A, Moreno G, Brown AF, Simmons S, Szilagyi P. Portals of Change: How Patient Portals Will Ultimately Work for Safety Net Populations. J Med Internet Res 2020; 22:e16835. [PMID: 33094732 PMCID: PMC7647808 DOI: 10.2196/16835] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 06/25/2020] [Accepted: 07/07/2020] [Indexed: 02/06/2023] Open
Abstract
Despite the implementation of internet patient portals into the safety net after the introduction of the Affordable Care Act in the United States, little attention has been paid to the process of engaging vulnerable patients into these portals. The portal is a health technology tool that was developed with a mainstream, English-speaking audience in mind. Thus, there are valid concerns that such technologies will actually exacerbate health care disparities, conferring further advantages to the already advantaged. In this paper, we describe a framework for portal engagement (awareness, registration, and use) among safety net patients. We incorporate the experiences in the Los Angeles County Department of Health Services to illustrate important contextual factors for portal outreach in our safety net. Finally, we discuss considerations for moving forward with health technology in the safety net as the next version of patient portals are being developed.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Anish Mahajan
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, Los Angeles, CA, United States
| | - Sara Simmons
- Los Angeles County Department of Health Services, Los Angeles, CA, United States
| | - Peter Szilagyi
- Department of Pediatrics, David Geffen School of Medicine, Los Angeles, CA, United States
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Saadatmand F, Dearfield C, Bronson J, Harrison R. Exposure to personal and community violence and associated drug use outcomes in African American young adults. J Ethn Subst Abuse 2020; 21:708-729. [PMID: 32729783 DOI: 10.1080/15332640.2020.1795040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Exposure to violence (ETV) during one's life has been associated with increased risk for substance abuse. Adolescent ETV is also related to substance abuse into adulthood, and has been shown to have a cumulative effect. This study adds to the understanding of how ETV relates to a range of substance use outcomes by specifying how different types of violence affects substance use behaviors in African American young adults, and examines how this exposure is moderated by other life stressors, and health and social experiences. METHOD Factor analysis was conducted to identify unique types of ETV in 638 African American men and women ages 18-25. The resulting factors represent 1) childhood ETV and 2) community ETV as adults. These were regressed upon substance abuse outcomes. RESULTS 78% of the respondents were exposed to some form of violence during their childhood. Lower childhood ETV were significantly associated with a lower risk of engaging in dangerous substance use behaviors. Adult experiences of community violence had more significant predictors of drug use than childhood ETV. Witnessing gunfire or an assault, witnessing or being a victim of sexual assault, and carrying a weapon were consistent risk factors for dangerous drug behaviors, although specific drug use behaviors differed across genders. CONCLUSIONS ETV served as an independent explanatory factor for specific drug use behaviors at different stages of life. Future research is needed to understand how these factors put respondents at risk for drug use behaviors or make them less likely to engage in dangerous use patterns.
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Affiliation(s)
| | - Craig Dearfield
- Department of Epidemiology, George Washington University, Washington, DC, USA
| | - Jennifer Bronson
- National Association of State Mental Health Program Directors Research Institute (NRI), Falls Church, Virginia, USA
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Casillas A, Cemballi AG, Abhat A, Lemberg M, Portz JD, Sadasivaiah S, Ratanawongsa N, Semere W, Brown A, Lyles CR. An Untapped Potential in Primary Care: Semi-Structured Interviews with Clinicians on How Patient Portals Will Work for Caregivers in the Safety Net. J Med Internet Res 2020; 22:e18466. [PMID: 32706709 PMCID: PMC7400036 DOI: 10.2196/18466] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background Patients within safety-net settings are less likely to access health information on patient portals, despite expressed interest. Family and friends are important resources to assist these patients (ie, Medicaid recipients, older patients, patients with limited English proficiency) in navigating health systems, and provider support of the use of patient portals among these groups may also facilitate caregivers’ use of their patients’ portal. Objective Because safety net providers work closely with caregivers to care for their patients, we used qualitative methods to explore safety net providers’ perspectives on portal use among caregivers for their patients, especially as there is limited literature about caregivers’ use of portals in the safety net. Methods We conducted 45- to 60-min semistructured telephone interviews with providers from three large California safety-net health systems. The interviews focused on providers’ experiences with caregivers, caregiver roles, and how the portal could be leveraged as a tool to support caregivers in their responsibilities. A total of three coders analyzed the interview transcripts using both deductive and inductive approaches and established a consensus regarding major themes. Results Of the 16 participants interviewed, 4 specialized in geriatrics, and all held a leadership or administrative role. We described themes highlighting providers’ recognition of potential benefits associated with caregiver portal use and specific challenges to caregiver engagement. Conclusions Providers recognized the potential for portals to improve information delivery and communication by helping caregivers assist socially and medically complex patients in the safety net. Providers in safety net sites also discussed a clear need for better ways to keep in touch with patients and connect with caregivers, yet security and privacy are perhaps of higher importance in these settings and may pose challenges to portal adoption. They noted that caregivers of patients in the safety net likely face similar communication barriers as patients, especially with respect to digital literacy, health literacy, and English proficiency. Further research is needed to assess and support caregivers’ interest and ability to access portals across barriers in health and digital literacy, and English proficiency. Portal platforms and health systems must also address specific strategies to uphold patient preferences while maintaining privacy and security.
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Affiliation(s)
- Alejandra Casillas
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Anupama Gunshekar Cemballi
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Anshu Abhat
- Los Angeles County Department of Health Services, Harbor-UCLA Medical Center, Los Angeles, CA, United States
| | - Miya Lemberg
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States
| | - Shobha Sadasivaiah
- Office of Health Informatics, San Francisco Health Network, San Francisco, CA, United States
| | - Neda Ratanawongsa
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Wagahta Semere
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
| | - Arleen Brown
- Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, United States
| | - Courtney Rees Lyles
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, UCSF Center for Vulnerable Populations, San Francisco, CA, United States
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Health Information-seeking Behaviors and Preferences of a Diverse, Multilingual Urban Cohort. Med Care 2020; 57 Suppl 6 Suppl 2:S176-S183. [PMID: 31095058 DOI: 10.1097/mlr.0000000000001050] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In order to address health disparities, it is important to understand how vulnerable individuals seek information. This study used an adapted version of the Health Information National Trends Survey (HINTS) administered in English, Spanish, and Chinese to describe the behaviors and preferences of a diverse group of vulnerable urban residents. METHODS We administered a modified HINTS survey in English, Spanish, and Chinese and used purposive sampling to ensure 50% were non-English speakers evenly divided between Spanish and Chinese speakers, and 50% of English-speakers identified as Black. We used multivariable logistic regression to determine characteristics associated with sources used for health information and preferences for delivery of health information. RESULTS Among 1027survey respondents (514 English, 256 Spanish, 260 Chinese), 55% had adequate health literacy, and 50% reported household income <$20,000, but 77% reported owning a smartphone. A plurality sought health information on the Internet (39%) or from a health care provider (36%). In multivariable analyses, smartphone ownership predicted higher odds of seeking health information on the Internet [odds ratio, (OR) 2.98; 95% confidence interval (CI), 1.81-4.91]. Participants most preferred email (41%) and brochures (40%) for delivery of health information, but non-English survey respondents were less likely to prefer email: Spanish (OR, 0.30; 95% CI, 0.11-0.83) and Chinese (OR, 0.25; 95% CI, 0.09-0.71). Smartphone ownership predicted an email preference (OR, 2.19; 95% CI, 1.43-3.36). CONCLUSIONS Among vulnerable populations, smartphone ownership and language preferences impact preferences for seeking and receiving health information. These preferences need to be considered in designing health messages.
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Odendaal WA, Anstey Watkins J, Leon N, Goudge J, Griffiths F, Tomlinson M, Daniels K. Health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 3:CD011942. [PMID: 32216074 PMCID: PMC7098082 DOI: 10.1002/14651858.cd011942.pub2] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Mobile health (mHealth), refers to healthcare practices supported by mobile devices, such as mobile phones and tablets. Within primary care, health workers often use mobile devices to register clients, track their health, and make decisions about care, as well as to communicate with clients and other health workers. An understanding of how health workers relate to, and experience mHealth, can help in its implementation. OBJECTIVES To synthesise qualitative research evidence on health workers' perceptions and experiences of using mHealth technologies to deliver primary healthcare services, and to develop hypotheses about why some technologies are more effective than others. SEARCH METHODS We searched MEDLINE, Embase, CINAHL, Science Citation Index and Social Sciences Citation Index in January 2018. We searched Global Health in December 2015. We screened the reference lists of included studies and key references and searched seven sources for grey literature (16 February to 5 March 2018). We re-ran the search strategies in February 2020. We screened these records and any studies that we identified as potentially relevant are awaiting classification. SELECTION CRITERIA We included studies that used qualitative data collection and analysis methods. We included studies of mHealth programmes that were part of primary healthcare services. These services could be implemented in public or private primary healthcare facilities, community and workplace, or the homes of clients. We included all categories of health workers, as well as those persons who supported the delivery and management of the mHealth programmes. We excluded participants identified as technical staff who developed and maintained the mHealth technology, without otherwise being involved in the programme delivery. We included studies conducted in any country. DATA COLLECTION AND ANALYSIS We assessed abstracts, titles and full-text papers according to the inclusion criteria. We found 53 studies that met the inclusion criteria and sampled 43 of these for our analysis. For the 43 sampled studies, we extracted information, such as country, health worker category, and the mHealth technology. We used a thematic analysis process. We used GRADE-CERQual to assess our confidence in the findings. MAIN RESULTS Most of the 43 included sample studies were from low- or middle-income countries. In many of the studies, the mobile devices had decision support software loaded onto them, which showed the steps the health workers had to follow when they provided health care. Other uses included in-person and/or text message communication, and recording clients' health information. Almost half of the studies looked at health workers' use of mobile devices for mother, child, and newborn health. We have moderate or high confidence in the following findings. mHealth changed how health workers worked with each other: health workers appreciated being more connected to colleagues, and thought that this improved co-ordination and quality of care. However, some described problems when senior colleagues did not respond or responded in anger. Some preferred face-to-face connection with colleagues. Some believed that mHealth improved their reporting, while others compared it to "big brother watching". mHealth changed how health workers delivered care: health workers appreciated how mHealth let them take on new tasks, work flexibly, and reach clients in difficult-to-reach areas. They appreciated mHealth when it improved feedback, speed and workflow, but not when it was slow or time consuming. Some health workers found decision support software useful; others thought it threatened their clinical skills. Most health workers saw mHealth as better than paper, but some preferred paper. Some health workers saw mHealth as creating more work. mHealth led to new forms of engagement and relationships with clients and communities: health workers felt that communicating with clients by mobile phone improved care and their relationships with clients, but felt that some clients needed face-to-face contact. Health workers were aware of the importance of protecting confidential client information when using mobile devices. Some health workers did not mind being contacted by clients outside working hours, while others wanted boundaries. Health workers described how some community members trusted health workers that used mHealth while others were sceptical. Health workers pointed to problems when clients needed to own their own phones. Health workers' use and perceptions of mHealth could be influenced by factors tied to costs, the health worker, the technology, the health system and society, poor network access, and poor access to electricity: some health workers did not mind covering extra costs. Others complained that phone credit was not delivered on time. Health workers who were accustomed to using mobile phones were sometimes more positive towards mHealth. Others with less experience, were sometimes embarrassed about making mistakes in front of clients or worried about job security. Health workers wanted training, technical support, user-friendly devices, and systems that were integrated into existing electronic health systems. The main challenges health workers experienced were poor network connections, access to electricity, and the cost of recharging phones. Other problems included damaged phones. Factors outside the health system also influenced how health workers experienced mHealth, including language, gender, and poverty issues. Health workers felt that their commitment to clients helped them cope with these challenges. AUTHORS' CONCLUSIONS Our findings propose a nuanced view about mHealth programmes. The complexities of healthcare delivery and human interactions defy simplistic conclusions on how health workers will perceive and experience their use of mHealth. Perceptions reflect the interplay between the technology, contexts, and human attributes. Detailed descriptions of the programme, implementation processes and contexts, alongside effectiveness studies, will help to unravel this interplay to formulate hypotheses regarding the effectiveness of mHealth.
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Affiliation(s)
- Willem A Odendaal
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Stellenbosch UniversityDepartment of PsychiatryCape TownSouth Africa
| | | | - Natalie Leon
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- Brown UniversitySchool of Public HealthProvidenceRhode IslandUSA
| | - Jane Goudge
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Frances Griffiths
- University of WarwickWarwick Medical SchoolCoventryUK
- University of the WitwatersrandCentre for Health Policy, School of Public Health, Faculty of Health SciencesJohannesburgSouth Africa
| | - Mark Tomlinson
- Stellenbosch UniversityInstitute for Life Course Health Research, Department of Global HealthCape TownSouth Africa
- Queens UniversitySchool of Nursing and MidwiferyBelfastUK
| | - Karen Daniels
- South African Medical Research CouncilHealth Systems Research UnitCape TownWestern CapeSouth Africa
- University of Cape TownHealth Policy and Systems Division, School of Public Health and Family MedicineCape TownWestern CapeSouth Africa7925
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Mold F, Hendy J, Lai YL, de Lusignan S. Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review. JMIR Med Inform 2019; 7:e13042. [PMID: 31793888 PMCID: PMC6918214 DOI: 10.2196/13042] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/11/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.
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Affiliation(s)
- Freda Mold
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Jane Hendy
- Brunel Business School, Brunel University London, Uxbridge, United Kingdom
| | - Yi-Ling Lai
- Faculty of Business and Law, University of Portsmouth, Portsmouth, United Kingdom
| | - Simon de Lusignan
- Nuffield Department of Primary Care Health Science, University of Oxford, Oxford, United Kingdom
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Hogan TP, Luger TM, Volkman JE, Rocheleau M, Mueller N, Barker AM, Nazi KM, Houston TK, Bokhour BG. Patient Centeredness in Electronic Communication: Evaluation of Patient-to-Health Care Team Secure Messaging. J Med Internet Res 2018; 20:e82. [PMID: 29519774 PMCID: PMC5864998 DOI: 10.2196/jmir.8801] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND As information and communication technology is becoming more widely implemented across health care organizations, patient-provider email or asynchronous electronic secure messaging has the potential to support patient-centered communication. Within the medical home model of the Veterans Health Administration (VA), secure messaging is envisioned as a means to enhance access and strengthen the relationships between veterans and their health care team members. However, despite previous studies that have examined the content of electronic messages exchanged between patients and health care providers, less research has focused on the socioemotional aspects of the communication enacted through those messages. OBJECTIVE Recognizing the potential of secure messaging to facilitate the goals of patient-centered care, the objectives of this analysis were to not only understand why patients and health care team members exchange secure messages but also to examine the socioemotional tone engendered in these messages. METHODS We conducted a cross-sectional coding evaluation of a corpus of secure messages exchanged between patients and health care team members over 6 months at 8 VA facilities. We identified patients whose medical records showed secure messaging threads containing at least 2 messages and compiled a random sample of these threads. Drawing on previous literature regarding the analysis of asynchronous, patient-provider electronic communication, we developed a coding scheme comprising a series of a priori patient and health care team member codes. Three team members tested the scheme on a subset of the messages and then independently coded the sample of messaging threads. RESULTS Of the 711 messages coded from the 384 messaging threads, 52.5% (373/711) were sent by patients and 47.5% (338/711) by health care team members. Patient and health care team member messages included logistical content (82.6%, 308/373 vs 89.1%, 301/338), were neutral in tone (70.2%, 262/373 vs 82.0%, 277/338), and respectful in nature (25.7%, 96/373 vs 33.4%, 113/338). Secure messages from health care team members sometimes appeared hurried (25.4%, 86/338) but also displayed friendliness or warmth (18.9%, 64/338) and reassurance or encouragement (18.6%, 63/338). Most patient messages involved either providing or seeking information; however, the majority of health care team member messages involved information provision in response to patient questions. CONCLUSIONS This evaluation is an important step toward understanding the content and socioemotional tone that is part of the secure messaging exchanges between patients and health care team members. Our findings were encouraging; however, there are opportunities for improvement. As health care organizations seek to supplement traditional encounters with virtual care, they must reexamine their use of secure messaging, including the patient centeredness of the communication, and the potential for more proactive use by health care team members.
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Affiliation(s)
- Timothy P Hogan
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Tana M Luger
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Psychology Field Group, Pitzer College, Claremont, CA, United States
| | - Julie E Volkman
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
- Department of Communication, Bryant University, Smithfield, RI, United States
| | - Mary Rocheleau
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Nora Mueller
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Anna M Barker
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
| | - Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Connected Care, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, United States
| | - Thomas K Houston
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Barbara G Bokhour
- Center for Evaluating Patient-Centered Care in the Veterans Health Administration, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States
- Department of Health, Law, Policy & Management, School of Public Health, Boston University, Boston, MA, United States
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Huygens MWJ, Swinkels ICS, Verheij RA, Friele RD, van Schayck OCP, de Witte LP. Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records. BMJ Open 2018; 8:e019233. [PMID: 29358442 PMCID: PMC5781222 DOI: 10.1136/bmjopen-2017-019233] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/02/2017] [Accepted: 10/19/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES It is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations. SETTING For this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014. PARTICIPANTS 200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients). PRIMARY OUTCOME MEASURES The number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account. RESULTS 32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger. CONCLUSION Even though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.
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Affiliation(s)
- Martine W J Huygens
- Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Center for Care Technology Research, Maastricht, The Netherlands
| | - Ilse C S Swinkels
- Center for Care Technology Research, Maastricht, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Robert A Verheij
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Roland D Friele
- Center for Care Technology Research, Maastricht, The Netherlands
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tranzo, The Netherlands
| | - Onno C P van Schayck
- Center for Care Technology Research, Maastricht, The Netherlands
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Luc P de Witte
- Centre for Assistive Technology and Connected Healthcare (CATCH), University of Sheffield, Sheffield, UK
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Shimada SL, Petrakis BA, Rothendler JA, Zirkle M, Zhao S, Feng H, Fix GM, Ozkaynak M, Martin T, Johnson SA, Tulu B, Gordon HS, Simon SR, Woods SS. An analysis of patient-provider secure messaging at two Veterans Health Administration medical centers: message content and resolution through secure messaging. J Am Med Inform Assoc 2018; 24:942-949. [PMID: 28371896 DOI: 10.1093/jamia/ocx021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/24/2017] [Indexed: 11/14/2022] Open
Abstract
Objective We sought to understand how patients and primary care teams use secure messaging (SM) to communicate with one another by analyzing secure message threads from 2 Department of Veterans Affairs facilities. Methods We coded 1000 threads of SM communication sampled from 40 primary care teams. Results Most threads (94.5%) were initiated by patients (90.4%) or caregivers (4.1%); only 5.5% were initiated by primary care team members proactively reaching out to patients. Medication renewals and refills (47.2%), scheduling requests (17.6%), medication issues (12.9%), and health issues (12.7%) were the most common patient-initiated requests, followed by referrals (7.0%), administrative issues (6.5%), test results (5.4%), test issues (5.2%), informing messages (4.9%), comments about the patient portal or SM (4.1%), appreciation (3.9%), self-reported data (2.8%), life issues (1.5%), and complaints (1.5%). Very few messages were clinically urgent (0.7%) or contained other potentially challenging content. Message threads were mostly short (2.7 messages), comprising an average of 1.35 discrete content types. A substantial proportion of issues (24.2%) did not show any evidence of being resolved through SM. Time to response and extent of resolution via SM varied by message content. Proactive SM use by teams varied, but was most often for test results (32.7%), medication-related issues (21.8%), medication renewals (16.4%), or scheduling issues (18.2%). Conclusions The majority of messages were transactional and initiated by patients or caregivers. Not all content categories were fully addressed over SM. Further education and training for both patients and clinical teams could improve the quality and efficiency of SM communication.
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Affiliation(s)
- Stephanie L Shimada
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA.,Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Bedford, MA, USA
| | - Beth Ann Petrakis
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - James A Rothendler
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Maryan Zirkle
- Portland VA Medical Center, Department of Veterans Affairs, Portland, OR, USA
| | - Shibei Zhao
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Hua Feng
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Gemmae M Fix
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | | | - Tracey Martin
- VISN1, Department of Veterans Affairs, Bedford, MA, USA
| | - Sharon A Johnson
- School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Bengisu Tulu
- School of Business, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Howard S Gordon
- Center for Innovation for Complex Chronic Healthcare, Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, USA.,Division of Academic Internal Medicine and Geriatrics, Department of Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Steven R Simon
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, Department of Veterans Affairs, Bedford, MA, USA
| | - Susan S Woods
- VA Maine Healthcare System, Connected Care Office, Veterans Health Administration, Augusta, ME, USA
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Alpert JM, Dyer KE, Lafata JE. Patient-centered communication in digital medical encounters. PATIENT EDUCATION AND COUNSELING 2017; 100:1852-1858. [PMID: 28522229 PMCID: PMC5573682 DOI: 10.1016/j.pec.2017.04.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 03/13/2017] [Accepted: 04/28/2017] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Patients are increasingly using the secure messaging function available through online patient portals to communicate with their health care providers, yet little is known about the characteristics of conversations that occur. The goal of this study is to describe the types of messages initiated by patients communicating via patient portals and to assess whether providers employ patient-centered strategies in their electronic responses. DESIGN A total of 193 messages from 58 message threads between patients and providers were collected during a one-week period in a large health care system. METHODS Content analysis of patient messages was conducted and deductive analysis of provider responses was employed for two types of patient-centered communication, provider use of supportive talk and partnership building. RESULTS Patients sent nearly double the number of messages compared to providers (65% versus 35%). Patient messages expressed concern, sought medical solutions and requested assistance with administrative tasks. Over half (53.4%) of provider replies did not contain language reflective of either partnership building or supportive talk. CONCLUSION Partnership building language and supportive talk occurred at lower rates than documented in the literature on in-person encounters. This may represent a lost opportunity to strengthen the patient-provider relationship. PRACTICE IMPLICATIONS As secure messaging is increasingly utilized as a form of patient-provider communication, it is important to understand how aspects of this communication channel, including the patient-centeredness of the language used by providers, impact patient-provider relationships and patient outcomes.
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Affiliation(s)
- Jordan M Alpert
- Department of Advertising, College of Journalism and Communications, University of Florida, United States.
| | - Karen E Dyer
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System,United States
| | - Jennifer Elston Lafata
- UNC Lineberger Comprehensive Cancer Center and UNC Eshelman School of Pharmacy, The University of North Carolina-Chapel Hill, United States
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Schillinger D, McNamara D, Crossley S, Lyles C, Moffet HH, Sarkar U, Duran N, Allen J, Liu J, Oryn D, Ratanawongsa N, Karter AJ. The Next Frontier in Communication and the ECLIPPSE Study: Bridging the Linguistic Divide in Secure Messaging. J Diabetes Res 2017; 2017:1348242. [PMID: 28265579 PMCID: PMC5318623 DOI: 10.1155/2017/1348242] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/12/2016] [Indexed: 11/18/2022] Open
Abstract
Health systems are heavily promoting patient portals. However, limited health literacy (HL) can restrict online communication via secure messaging (SM) because patients' literacy skills must be sufficient to convey and comprehend content while clinicians must encourage and elicit communication from patients and match patients' literacy level. This paper describes the Employing Computational Linguistics to Improve Patient-Provider Secure Email (ECLIPPSE) study, an interdisciplinary effort bringing together scientists in communication, computational linguistics, and health services to employ computational linguistic methods to (1) create a novel Linguistic Complexity Profile (LCP) to characterize communications of patients and clinicians and demonstrate its validity and (2) examine whether providers accommodate communication needs of patients with limited HL by tailoring their SM responses. We will study >5 million SMs generated by >150,000 ethnically diverse type 2 diabetes patients and >9000 clinicians from two settings: an integrated delivery system and a public (safety net) system. Finally, we will then create an LCP-based automated aid that delivers real-time feedback to clinicians to reduce the linguistic complexity of their SMs. This research will support health systems' journeys to become health literate healthcare organizations and reduce HL-related disparities in diabetes care.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Danielle Oryn
- Redwood Community Health Coalition, Petaluma, CA, USA
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Mirsky JB, Tieu L, Lyles C, Sarkar U. Readability assessment of patient-provider electronic messages in a primary care setting. J Am Med Inform Assoc 2016; 23:202-6. [PMID: 26177659 PMCID: PMC7814916 DOI: 10.1093/jamia/ocv087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/11/2015] [Accepted: 05/28/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The high prevalence of limited health literacy among patients threatens the success of secure electronic messaging between patients from diverse populations and their providers. OBJECTIVE The purpose of this study is to generate hypotheses about the readability of patient and provider electronic messages. METHODS We collected 31 patient-provider e-mail exchanges (n = 119 total messages) from a safety-net primary care clinic. We compared the messages' mean word count and Flesch-Kincaid Grade Levels (FKGLs), calculated the frequency of provider messages below an FKGL = 8, and assessed readability concordance between patients' and providers' messages. RESULTS Patients used more words in their initial e-mails compared to providers, but the FKGLs were similar, and 68% of provider messages were written below an FKGL = 8. Of 31 exchanges, 9 (29%) contained at least one patient message with an FKGL > 3 grade levels lower than the corresponding provider message(s). CONCLUSION Our study demonstrates that most providers are able to respond to patient electronic messages with a matching reading level.
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Affiliation(s)
- Jacob B Mirsky
- University of California, San Francisco, School of Medicine
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital
| | - Courtney Lyles
- Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital
| | - Urmimala Sarkar
- Division of General Internal Medicine, University of California, San Francisco, School of Medicine and UCSF Center for Vulnerable Populations at San Francisco General Hospital
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