Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation

doi:10.1016/j.ijmedinf.2009.06.002

International Journal of Medical Informatics

Volume 78, Issue 10, October 2009, Pages 688-703

https://doi.org/10.1016/j.ijmedinf.2009.06.002 Get rights and content

Abstract

Objective

To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).

Methods

We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.

Results

In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups – the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors – were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.

Conclusion

In order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption 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:

•
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].
•
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].
•
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:

•
Direct e-consultation: consulting a GP through secured e-mail.
•
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:

•
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].
•
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.

References (33)

C.B. White et al.
A content analysis of e-mail communication between patients and their providers: patients get the message
J. Am. Med. Inform. Assoc.
(2004)
G. Umefjord et al.
Medical text-based consultations on the Internet: a 4-year study
Int. J. Med. Inform.
(2008)
J. Hobbs et al.
Opportunities to enhance patient and physician e-mail contact
Int. J. Med. Inform.
(2003)
B.W. Hesse et al.
eHealth research from the user's perspective
Am. J. Prev. Med.
(2007)
A.J.G. van Rijen, The Internet user and changes in health care, Statistics Netherlands, 2005...
S. Fox, J. Vitak, Degrees of access, Pew Internet & American Life Project, 2008...
E.B. Beckjord et al.
Use of the Internet to communicate with health care providers in the United States: estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS)
J. Med. Internet Res.
(2007)
P.E. Kummervold et al.
eHealth trends in Europe 2005–2007: a population-based survey
J. Med. Internet Res.
(2008)
R.G. Brooks et al.
Physician use of e-mail with patients: factors influencing electronic communication and adherence to best practices
J. Med. Internet Res.
(2006)
C.A. Moyer et al.
Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care
Am. J. Manag. Care
(2002)

B. Gaster et al.

Physicians’ use of and attitudes toward electronic mail for patient communication

J. Gen. Intern. Med.

(2003)

J. Car et al.

Email consultations in health care: 1-scope and effectiveness

BMJ

(2004)

G. Umefjord et al.

Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor Service

J. Med. Internet Res.

(2003)

G. Umefjord, Internet consultation in medicine: studies of a text-based Ask the Doctor Service [dissertation], Umeå...

F. Verhoeven et al.

The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review

J. Med. Internet Res.

(2007)

E.H. Wagner et al.

Finding common ground: patient-centeredness and evidence-based chronic illness care

J. Altern. Complement. Med.

(2005)

Cited by (58)

Revealing the complexity of users’ intention to adopt healthcare chatbots: A mixed-method analysis of antecedent condition configurations
2023, Information Processing and Management
Healthcare chatbots provide a professional, immediate, and low-cost tool for advising people on health information. Unlike previous studies on chatbot adoption that focus on the one-way net effect of components, this study reveals the complex antecedent configurations behind online healthcare chatbot adoption through an asymmetric approach. This study attempts to explain the causal configuration of user adoption in terms of three dimensions: functional, social, and user motivation features. A sequential mixed-method approach was chosen and a two-stage study, fuzzy set comparison analysis (fsQCA), and semi-structured interviews were conducted to deepen users' understanding, perceptions, and attitudes toward online healthcare chatbots, expressing more fine-grained insights into variable relationships. Five configurations were found to explain the high willingness of users to adopt healthcare chatbots. Perceived social presence was a core condition for each configuration. However, the social features of chatbots can only lead to high levels of trust and satisfaction when combined with functionality. The findings of this paper's mixed-method design and complexity study contribute to the adoption and theoretical literature on intelligent health services and chatbots. It guides tailoring chatbot functionality to individual user needs and provides practical guidance for the development of chatbots for health services through diverse combinations of machine chatbot features and user-motivated features.
Electronic healthcare applications and programs among healthcare workers in Riyadh and conflict management
2022, Journal of Taibah University Medical Sciences
Citation Excerpt :
Studies have showed that young people used mobile applications better.33 However, one study found that elderly patients had high motivation to use electronic counselling services.34 Our study found that gender did not significantly affect the participants’ satisfaction with e-health applications.
Electronic healthcare applications and programmes enable the use of computers, networks, and information technology to improve healthcare quality and patient safety, and secure confidential access to health information in order to enable individuals and communities to make the best possible health decisions. We study conflicts challenging users of e-health electronic applications and programmes in Riyadh.
We use a cross-sectional descriptive design to target all healthcare professionals who interact with e-health applications and programmes. Healthcare providers took a questionnaire survey online.
Of the 169 responses to our questionnaire, 78.1% are female, and 46.2% are aged between 31 and 40 years. As many as 59.2% always use these applications, and 33.7% use them occasionally. Only 7.10% of the participants rarely or never use them. As many as 31.4% recognized that these applications led to conflicts at the workplace. Of these, 50.6%, 13.6%, and 35.8% stated that they caused decision-related, ethical, and other types of conflicts, respectively.
We conducted this study among healthcare providers in Riyadh, KSA, and found that the use of e-health applications and programmes encountered some difficulties.
My time, your time, our time. Older patients’ and GPs’ time sensibilities around email consultations
2024, Health Sociology Review
A Chinese case to satisfy the patient journey: optimal service configuration for online health service platforms
2024, Journal of Information Technology Case and Application Research
Should Doctors Open Online Consultation Services? An Empirical Investigation of Their Impact on Offline Appointments
2023, Information Systems Research
Satisfying the patient journey: optimal service configuration for online health service platforms
2023, Research Square

View all citing articles on Scopus

View full text

Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation

Abstract

Objective

Methods

Results

Conclusion

Introduction

Section snippets

Survey instrument

Study participants

Discussion

Conclusions

Acknowledgements

J. Am. Med. Inform. Assoc.

Int. J. Med. Inform.

Int. J. Med. Inform.

Am. J. Prev. Med.

Use of the Internet to communicate with health care providers in the United States: estimates from the 2003 and 2005 Health Information National Trends Surveys (HINTS)

J. Med. Internet Res.

eHealth trends in Europe 2005–2007: a population-based survey

J. Med. Internet Res.

Physician use of e-mail with patients: factors influencing electronic communication and adherence to best practices

J. Med. Internet Res.

Bridging the electronic divide: patient and provider perspectives on e-mail communication in primary care

Am. J. Manag. Care

Physicians’ use of and attitudes toward electronic mail for patient communication

J. Gen. Intern. Med.

Email consultations in health care: 1-scope and effectiveness

BMJ

Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor Service

J. Med. Internet Res.

The contribution of teleconsultation and videoconferencing to diabetes care: a systematic literature review

J. Med. Internet Res.

Finding common ground: patient-centeredness and evidence-based chronic illness care

J. Altern. Complement. Med.