Physicians’ Use of Email With Patients: Factors Influencing Electronic Communication and Adherence to Best Practices

Abstract

Background With the public’s increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, email use by physicians for clinical care has been slow.Objective To examine the factors associated with physician-patient email, and report on the physicians’ adherence to recognized guidelines for email communication.Methods Cross-sectional survey (March–May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics.Results The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used email to communicate with patients. Only 120 (2.9%) used email with patients frequently. In univariate analysis, email use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to email use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for email communication.Conclusions This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of email communication, and little adherence to recognized guidelines for email correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of email communication, and to remove fiscal and legal barriers to its adoption.

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

“…58 A recent survey of all primary care and ambulatory specialty physicians in Florida showed only modest advances in the adoption of e-mail communication, and little adherence to recognized guidelines for e-mail correspondence. 100 A study of 200 patients with rheumatoid arthritis who initiated their own follow-up found patients were significantly more confident and satisfied with their care and used fewer specialty services, including fewer hospitalizations, and saw their primary care physician as frequently as a matched control group for whom specialty care was more limited. 76 These findings again suggest that the primary care physician's role as a gate opener and advisor may be more efficient than as a gatekeeper.…”

Telemedicine in Primary Care

“…(Lacher et al, 2000) A study in 2006, 16.6% of 4203 Florida physicians used email from their office for communication with patients; 17.4% of those physicians (or 2.9% of the total number of physicians) used emails with patients on daily basis. (Brooks & Menachemi, 2006) A following survey representing the same population in 2008 revealed a slight increase in the percentage of physicians who use email (20%). (Menachemi et al, 2011) …”

Interventions for promoting information and communication technologies adoption in healthcare professionals

“…With increasing computerisation in every sector of activity, ICTs are expected to become tools that are part of healthcare professional practice. Nonetheless, it appears that ICTs such as electronic medical records and the Internet remain underused by healthcare professionals (Berner 2005;Brooks 2006). Human and organisational factors have been identified as the main causes of ICT implementation failure (Aarts 2004;Lorenzi 1997;Pagliari 2005).…”