Modeling and Predicting Outcomes of eHealth Usage by European Physicians: Multidimensional Approach from a Survey of 9196 General Practitioners (Preprint)

Abstract

Background: In the shared healthcare model that eHealth proposes, the literature has noted the need to use more advanced methods and models to evaluate physicians' eHealth usage outcomes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of European general practitioners' eHealth usage outcomes. Methods: We used data from a 2012-2013 survey of a sample of 9,196 European general practitioners. We proposed and tested two composite indicators of eHealth usage outcomes (internal practices [IP] and practices with patients [PP]) by means of two-stage structural equation modeling with latent variables and measurement errors. Logistic regression (odds ratios, OR) to model the predictors of eHealth usage outcomes indicators was performed using independent variables corresponding to sociodemographic circumstances, attitudes towards ICT impact, and working conditions. Results: The dimensions with more explanatory power of eHealth usage outcomes in internal practices were ICT usage, electronic health records_data, electronic health records_decision support systems, personal health records and Telehealth. In contrast, the eHealth usage outcomes in practices with patients were only explained by the composite indicator of eHealth usage outcomes in the internal practices and by Telehealth usage. For 54.8% (5,035/9,196) and for 55.8% (5,133/9,196) of European general practitioners, the eHealth usage outcomes in internal practices and in practices with patients were more favorable (greater than the mean). European general practitioners who were female (IP OR 1.15, 95% CI 1.10-1.20; PP OR 1.19, 95% CI 1.14-1.24) and younger -aged < 35 years (IP OR 1.14, 95% CI 1.02-1.26; PP OR 1.32, 95% CI 1.13-1.54) and aged 36-45 years (IP OR 1.16, 95% CI 1.06-1.28; PP OR 1.21, 95% CI 1.10-1.33) -had a higher propensity towards favorable eHealth usage outcomes in internal practices (IP) and in practices with patients (PP). European general practitioners who positively valued the effect of ICT on their personal work processes (IP OR 5.30, 95% CI 4.73-5.93; PP OR 4.83, 95% CI 4.32-5.40), teamwork processes (IP OR 4.19, 95% CI 3.78-4.65; PP OR 3.38, 95% CI 3.05-3.74) and relations with patients (IP OR 3.97, 95% CI 3.60-4.37; PP OR 6.02, 95% CI 5.43-6.67) showed a high propensity towards the favorable results of eHealth uses (IP and PP). European general practitioners who had used 2.0 applications in their personal lives frequently (IP OR 1.77, 95% CI 1.60-1.97; PP OR 1.94, 95% CI 1.74-2.15) or occasionally (IP OR 1.16, 95% CI 1.06-1.28; PP OR 1.19, 95% CI 1.08-1.31) also had a high propensity towards favorable eHealth usage outcomes. Self-employed European general practitioners (IP OR 1.33, 95% CI 1.22-1.45; PP OR 1.10, 95% CI 1.03-1.28) also showed more favorable results in eHealth usage. Lastly, general practitioners who reported that the number of patients treated had remained constant (IP OR 1.08, 95% CI 1.01-1.17) or had increased in the last two years (PP OR 1.12, 95% CI 1.03-1.22) had a ...