June 16, 2009

Most Older Patients Enthusiastic About Emails To And From Doctors

 Nearly half of patients over the age of 65 said they were enthusiastic about the possibility of email communication with their physicians, even though less than 2 percent corresponded that way at the time of a 2003 survey, said researchers at the Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine in collaboration with those at the University of California at Los Angeles in a report in the Journal of Medical Internet Research.

"I think the enthusiasm would be even greater now," said Dr. Hardeep Singh, an investigator in the Houston VA Health Services Research and Development Center of Excellence at the Michael E. DeBakey Veterans Affairs Medical Center and an assistant professor of medicine at BCM.

An analysis of data from surveys of 4,059 patients over age 65 and 181 physicians carried out in Southern California showed that while only 52 patients reported communicating with their physicians by email, nearly half (49.3 percent) said they were enthusiastic about the possibility of using the electronic communication. The older the patients were, the less likely they were to consider using email.

However, African-Americans, Hispanics and men were more likely to say they would use email. Those who thought their doctors had good communications skills or those who felt that communication was not as good when they talked to their doctors during regular visits were also more likely to be willing to use email.

Physician attitudes also played an important role, said Singh.

"If the physician is enthusiastic about email, the patients are more likely to be as well," he said. Half of the physicians in the survey were less likely to be eager to use email.

"For physicians, the major issues are physician time and compensation," he said. "If I am a practicing physician and I get 25 emails a day from my patients, I would love to respond to all of them. However, time gets in the way."

Reimbursement from Medicare or private insurers for such communications would make it easier for physicians to budget such time, he said.

Educating patients and physicians about using email in this way will be important, he said. Urgent or emergency health concerns should never be communicated by email because physicians may not be able to respond promptly. Emails must also be succinct, he said.

"Patients should try not to send their doctors excessively lengthy emails addressing complicated issues. Complex health care interactions are perhaps best left for face to face appointments" he said.

Physician education will be important as well, he said.

"I think email use has tremendous future potential in health care," he said. "For instance, doctors often spend time writing down detailed instructions for patients on paper and these paper notes are sometimes lost. Similarly, we write patient instructions about medication changes and follow-up appointments in the electronic record. It would be really useful to get these instructions to our patients through secure email. They can always then have them accessible."

Others who took part in this research include Nancy J. Petersen, Anila Shethia, and Richard L. Street, Jr., all of BCM and Sarah A Fox of the Geffen School of Medicine, University of California, Los Angeles. Street is also with Texas A&M University department of communication.

Funding for this work came from the National Cancer Institute and the Houston VA HSR&D Center of Excellence.


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