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

The survey included questions about: (1) current Internet and E-mail access; (2) how likely it was that patients would use E-mail for selected clinical services, if available, scored on a 5-point Likert scale; (3) what in their opinion was a reasonable response time to their E-mail communication about routine laboratory results, prescription refills, and medical questions; and (4) demographic information including sex, age, race/ethnicity, education, and annual family income.

Statistical Analysis

Data management and analysis were performed using SPSS software¹⁶ on a personal computer. We determined the proportion of patients with access to the Internet and E-mail by clinic. Overall, reported desired areas for using E-mail for selected clinical services were computed as the combined responses of 3 to 5 on the 5-point Likert scale. Reported desired areas for using E-mail were also computed as mean responses on the scale. We determined patient expectations regarding the timeliness of their E-mail queries. Group differences were assessed for significance using the c² statistic or Fisher exact test for categorical data and the nonparametric Kruskal-Wallis analysis of variance test for ordinal (Likert-style) data. Finally, multivariate logistic regression modeling was used to control for measured covariates on the 5 main outcome variables. All tests were 2-tailed and considered significant at P less than .05.

Results

E-mail Access

Overall, 54.3% of the patients reported having E-mail access, with a significant wide variation (33%-75%) among the 6 clinics Table 1. Internet access rates mirrored those of E-mail access rates.

Desired Areas for Using E-mail

On the basis of the combined responses of 3 to 5 on the 5-point Likert scale, we found that patients most wanted to use E-mail to request prescription refills (90%), for nonurgent consultations (87%), and to obtain routine laboratory results or test reports (84%). Using E-mail to make or cancel appointments (78%) was the area of least interest reported by all patients Figure 1.

The reported desire to use E-mail for selected clinical services varied by patient demographic characteristics, using mean responses on the 5-point Likert scale. However, after multivariate adjustment for other measured variables, we only found 2 significant associations. African Americans were somewhat less likely than other groups to want to use E-mail to get laboratory results or test reports, and older patients were significantly less interested in using E-mail to consult a nurse on nonurgent simple medical questions.

Timeliness of Responses to E-mail Queries

Patients’ expectations of the timeliness of responses to their E-mail queries varied significantly by selected clinical services but not by clinic. For routine laboratory results, for example, their expectations were: less than 9 hours, 21%; 9 to 24 hours, 53%; and more than 24 hours, 26% Table 2.

No sex or racial/ethnic differences were found regarding the timeliness of responses to E-mail queries for the 3 selected clinical services. Additionally, there were no demographic differences for the timeliness of responses to E-mail queries about prescription refills. However, there were significant age group and income differences in the timeliness of responses to patients’ E-mail queries on laboratory results or test reports. Although the majority of patients in each age group expected a response to their E-mail queries on laboratory results or test reports within 24 hours, only 6% of patients aged 65 years and older expected a response later than 24 hours compared with 20% to 29% of patients in other age groups. Surprisingly, patients with annual family incomes at both extremes had significantly higher expectations for the timeliness of responses to E-mail queries on laboratory results or test reports than their counterparts in the middle income brackets. Also, patients with educational levels at both extremes, particularly those with less than a high school education, had significantly higher expectations regarding the timeliness of responses to queries on medical questions Table 3.

Discussion

Our findings confirmed some of our suppositions and brought new information to light. We were not surprised to find that slightly more than 50% of our patients had E-mail and Internet access. This statistic is similar to those reported in other published literature.^2,3 However, we could not completely explain the large variation from site to site within our own health care system. One plausible explanation for the relatively high rate of E-mail access observed at the Bryan/College Station Clinic is its location in a university town, where the clinic clientele is more likely to have an overall higher level of education than that in some of our other sites.

Recently it was reported in the Dallas Business Journal¹⁷ that nearly half of 1000 adult patients interviewed during a Laurus Health.com telephone survey said they would like to have E-mail access to their physician’s appointment scheduling system. In our study, we found a very strong desire for this service (78%) among our patient population. The Laurus Health.com survey also reported that 37% of all patients wanted electronic access to their test results. Our study found that 84% of our patients with E-mail access desired this capability. In fact, our study found a degree of interest in electronic communication with their health care provider that was very similar to that of a University of Michigan study of patients in a general medicine clinic. In the University of Michigan study, 70% of patients surveyed indicated their willingness to communicate with their health care provider using E-mail.¹⁸