E-Health
E-mail in patient–provider communication: A systematic review

https://doi.org/10.1016/j.pec.2009.09.038Get rights and content

Abstract

Objective

To review systematically the role of e-mails in patient–provider communication in terms of e-mail content, and perspectives of providers and patients on e-mail communication in health care.

Methods

A systematic review of studies on e-mail communication between patients and health providers in regular health care published from 2000 to 2008.

Results

A total of 24 studies were included in the review. Among these studies, 21 studies examined e-mail communication between patients and providers, and three studies examined the e-mail communication between parents of patients in pediatric primary care and pediatricians. In the content analyses of e-mail messages, topics well represented were medical information exchange, medical condition or update, medication information, and subspecialty evaluation. A number of personal and institutional features were associated with the likelihood of e-mail use between patients and providers. While benefits of e-mails in enhancing communication were recognized by both patients and providers, concerns about confidentiality and security were also expressed.

Conclusion

The e-mail is transforming the relationship between patients and providers. The rigorous exploration of pros and cons of electronic interaction in health care settings will help make e-mail communication a more powerful, mutually beneficial health care provision tool.

Practice implications

It is important to develop an electronic communication system for the clinical practice that can address a range of concerns. More efforts need to be made to educate patients and providers to appropriately and effectively use e-mail for communication.

Introduction

Communication is an essential component of patient care. A wealth of evidence has shown that effective communication between providers and patients may positively influence patients’ behaviors and well-being, including satisfaction with care, medication adherence, recall and comprehending of medical information, and functional and physiological status [1], [2], [3], [4], [5], [6]. Traditionally, face-to-face communication and telephone communication have been the primary means for the patients to interact with their health providers. However, with advances in technology, Internet applications for communications, particularly electronic mail (e-mail), are emerging as another viable avenue for patient communication. The popularity of e-mail in daily life is attributable to some of its unique characteristics, such as asynchronous communication and rapid message transfer. Despite the simplicity and efficiency of e-mail, the medical profession has been slow in embracing it as a means of improving patient communications [7], [8].

According to the American Medical Association, the provider needs to take on an explicit measure of responsibility for the patient's care in provider–patient e-mail. Providers who choose to utilize e-mail for patient and medical practice communications are required to follow the communication, medicolegal, and administrative guidelines [9]. These guidelines apply to electronic communication within an established partnership. Attention is particularly paid to informed consent, confidentiality, and record keeping of e-mail exchanges.

In recent years, with the increasing penetration of the Internet, many studies have been conducted to examine E-communication between providers and patients. This review aimed to improve understanding of the role of e-mail in patient–provider communication. In this report, we assess: (1) the content of e-mail communication between patients and providers; (2) patients’ use of and attitudes toward e-mail communication with providers; and (3) providers’ use of and attitudes toward e-mail communication with patients.

Section snippets

Methods

This review was carried out using systematic methods to produce a narrative summary. Relevant studies were identified using a systematic search of the computerized databases including PubMed/MEDLINE, ProQuest, and PsycINFO. The following terms were used, in various combinations, in the search: e-mail, electronic communication, doctor–patient communication, physician–patient communication, patient–doctor communication, patient–physician communication, primary care, health care, family medicine,

Results

A total of 24 studies were included in the review. Among these studies, 21 studies examined patient–provider e-mail communication, and three studies examined the e-mail communication between parents of patients in pediatric primary care and their pediatricians. Most of the studies used cross-sectional surveys that were conducted in different formats, including in-person/paper-based survey, Internet-based/e-mail survey, and mailed survey. Six studies analyzed the content of e-mail messages from

Discussion

With the further penetration of information technology in the past decade, there is a growing body of literature regarding electronic communication between providers and patients. This systematic review identified 24 studies that focused on certain aspects of e-mail communication in health care. Because of heterogeneity of study design, outcome measures and other methodological features, the results were presented descriptively, focusing on e-mail content and features, patients’ perspectives,

References (36)

  • N. Kerse et al.

    Physician–patient relationship and medication compliance: a primary care investigation

    Ann Fam Med

    (2004)
  • T. Bodenheimer et al.

    Electronic technology: a spark to revitalize primary care

    J Am Med Assoc

    (2003)
  • American Medical Association. Guidelines for physician–patient electronic communication. Available at...
  • S.G. Anand et al.

    Content analysis of e-mail communication between primary care providers and parents

    Pediatrics

    (2005)
  • S.L. Leong et al.

    Enhancing doctor–patient communication using email: a pilot study

    J Am Board Fam Pract

    (2005)
  • P. Rosen et al.

    Patient–physician e-mail: an opportunity to transform pediatric health care delivery

    Pediatrics

    (2007)
  • D.L. Roter et al.

    Can e-mail messages between patients and physicians be patient-centered?

    Health Commun

    (2008)
  • D.F. Sittig

    Results of a content analysis of electronic messages (email) sent between patients and their physicians

    BMC Med Inform Decis Mak

    (2003)
  • Cited by (154)

    View all citing articles on Scopus
    View full text