Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation
Introduction
These days the use of the Internet as a source for health information has increased substantially [1], [2], [3], [4]. Therefore, we could expect that secured systems for online asynchronous patient-caregiver communication, such as e-consultation, would be incorporated into medical practice. However, the use of e-consultation remains relatively low [1], [3], [5], [6], [7]. This seems rather paradoxical since e-consultation has many potential benefits such as:
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Increased access to care. Patients can ask questions from any place and at any time, anonymous consultation is possible for sensitive questions and the service facilitates a second opinion [8], [9], [10].
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Increased self-management support for individuals with significant medical problems; e-consultation use can empower patients’ self-control skills and strengthen their autonomy, especially when the service is used as part of a disease-management program for monitoring chronic diseases [11], [12], [13], [14], [15].
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Reduced costs while maintaining the same or achieving better quality of care [11], [15]. This means that e-consultation can respond to an increasing demand for care in the aging society, provided that e-consultation will be widely used.
The main purpose of this study was to identify factors that can increase the use of e-consultation among non-users: patients with access to Internet, but with no prior e-consultation experience. We carried out an online survey among non-users in order to assess their barriers towards e-consultation, their demands regarding e-consultation and their motivations to use e-consultation. We investigated the motivations for using two types of e-consultation, which are being provided in the Netherlands:
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Direct e-consultation: consulting a GP through secured e-mail.
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Indirect e-consultation: consulting a GP through secured e-mail with intervention of a Web-based triage system.
The systems for direct and indirect e-consultation have been described in more detail in a previous study [16]. Web-based triage systems for e-consultation have been developed to prevent unnecessary visits to the doctor by promoting self-care advice. Web-based triage systems consist of a symptom-driven question-and-answer system for filtering urgent complaints. Patients have to label their health complaint either on alphabetically ordered lists or on a virtual body. Subsequently, they have to run through the questions and answers related to the identified problem. In the event of urgent symptoms the Web-based triage application generates advice to visit a doctor. In the event of non-urgent issues it generates a tailored self-care advice. Through this study we hoped to assess whether patients are motivated to use such e-consultation services.
We also identified socio-demographic and health-related characteristics of non-users in order to find out how these factors affect e-consultation use. Therefore, we assessed barriers, demands and motivations regarding e-consultation of different patient groups, to know:
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Patient groups that could benefit especially from e-consultation because of their increasing demand for care such as elderly patients, frequent GP visitors, chronic medication users, because Internet users with more medical problems may have a more frequent need to use e-consultation [3].
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Patient groups that have a significant chance of being left behind such as less-educated patients, because Internet users with lower levels of education were less inclined to use e-consultation than Internet users with higher levels of education [3], [6].
Section snippets
Survey instrument
We used an online survey to assess the factors that can enhance e-consultation use among Dutch primary care patients who have Internet access, but lack experience with e-consultation. The survey covered 7 main topics and contained a total of 45 items. Topic 1 asked whether patients had experience with e-consultation (Yes/No). Topics 2–6 consisted of multiple statements, which could be answered on a 5-point scale ranging from strongly disagree (1) to strongly agree (5). The statements were based
Study participants
Of the total sample (n = 1706), 163 patients (9.6%) had experience with e-consultation. Of the remaining 1543 patients (90.4%) who had no prior e-consultation experience, only 1066 patients were eligible for the analysis. We excluded the patients who had filled out only 1 question. The n varies, because patients could skip questions.
In this study we describe the results of the 1066 patients with no e-consultation experience. Table 1 shows that most patients were female (62.4%) and frequent
Discussion
These days e-consultation provides more advanced services, such as Web-based triage features for decision-making assistance and for promoting patient self-care [16]. Therefore, we would expect that e-consultation would be widespread in today's technological age. However, this is not the case. About 90% of our total sample (n = 1706) had never encountered e-consultation.
In this study we aimed to identify factors that can increase the use of e-consultation in primary care. With an online survey, we
Conclusions
The findings of this study demonstrate that the use of e-consultation will not increase through efforts to change the attitudes of patients or health care providers, since many non-users liked the possibilities of e-consultation and were thus motivated to use e-consultation. Increase in use will rather occur through solving existing barriers among non-users [16], [31] and through addressing patients’ demands, preferences and skills when developing e-consultation systems [16], [20], [32], [33].
Acknowledgements
This study was supported by The Federation of Patients and Consumer Organizations in the Netherlands.
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