Perceived Barriers to and Facilitators of Patient-to-Provider E-Mail in the Management of Diabetes Care

Popeski, Naomi; McKeen, Caitlin; Khokhar, Bushra; Edwards, Alun; Ghali, William A.; Sargious, Peter; White, Deborah; Hebert, Marilynne; Rabi, Doreen M.

doi:10.1016/j.jcjd.2015.07.001

Cited by 13 publications

(22 citation statements)

References 8 publications

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“…Subgroup analysis indicated no significant change in the frequency of visits between high messaging users, or for those who had used messaging for longer. In other studies, e-consultations were found not to reduce telephone consultations [79] or number of office visits [70]. Evidence focusing on return visits to primary care found no significant differences in rates of early return visits for the same reason (e-consultations 20.2%, 46/228; face-to-face 19.6%, 98/500; P =.86) [58].…”

Section: Resultsmentioning

confidence: 91%

“…Patients reported using e-consultations when they did not perceive that a face-to-face consultation as warranted, even if conditions were chronic and long term such as diabetes and hypertension [29,57,79], or in cases where symptoms were routine or nonurgent, such as skin conditions, low-level pain, sleep issues, hemorrhoids, coughs, or sinusitis [29,48,79,81,83]. Unlike other studies, email contents analysis in 1 study suggests emails are useful when patients want to request information (symptom updates) or simple provider action (referrals, medications, treatments, or test result information) [63].…”

Section: Resultsmentioning

confidence: 99%

“…Convenience was the primary reported reason for choosing an e-consultation by patients across multiple studies [35,38,41,45,48,67,79,83]. Patient satisfaction [32,51,59,66,70] with immediate care received was increased [81] in the short term at 6 months [52].…”

Section: Resultsmentioning

confidence: 99%

“…Several studies report clinicians’ reluctance to use email with their patients because of increased workload concerns [37,40,46,84]. Clinicians reported improved efficiencies as email or secure messaging was described as taking little additional time [70] and encouraged care access [79]. However, as time is cumulative, even small additions, for example, between 2 and 6 min per email consultation [84], may lengthen the working day [70,76].…”

Section: Resultsmentioning

confidence: 99%

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Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Mold¹,

Hendy²,

Lai³

et al. 2019

JMIR Med Inform

138

155

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BackgroundGovernments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain.ObjectiveThis study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care.MethodsA systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis.ResultsThis review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes.ConclusionsE-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Mold¹,

Hendy²,

Lai³

et al. 2019

JMIR Med Inform

138

155

View full text Add to dashboard Cite

show abstract

“…4 Another study of physicians and allied health professionals, which used focus group interviews to investigate the use of patient E-mails in the clinical care of patients with diabetes, found that most physicians did not E-mail patients directly and were uncertain about its potential to improve care. 25 By contrast, the allied health professionals used E-mail frequently and perceived value in the service. When focusing more narrowly on live interactive video visits, few studies have investigated use and provider perceptions in primary care settings.…”

mentioning

confidence: 99%

Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

et al. 2017

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Purpose:Little is known about the attitudes toward and adoption of telehealth services among family physicians (FPs), the largest primary care physician group. We conducted a national survey of FPs, randomly sampled from membership organization files, to investigate use of and barriers to using telehealth services.Methods: Using bivariate analyses, we examined how telehealth usage affected FPs' identified barriers to using telehealth services. Logistic regressions show the factors associated both with using telehealth services and with barriers to using telehealth services.Results: Surveys reached 4980 FPs; 1557 surveys were eligible for analysis (31% response rate). Among FPs, 15% reported using telehealth services during 2014. After controlling for the characteristics of the physicians and their practice, FPs who were based in a rural setting, worked in a practice owned by an integrated health system or other ownership structure, and provided hospital/urgent/emergency care were more likely to use telehealth. Physician and practice characteristics by telehealth use status, sex of the physician, practice location, years in practice, care provided, and practice ownership were associated with the barriers identified. As health care delivery in the United States transitions to a patient-centered, value-based system with improved access to services, physician availability is a challenge. Telehealth could help address this problem. Although the term telehealth has been widely applied and well recognized for more than 4 decades, it lacks a singular definition. Broadly, telehealth is the use of technology to deliver health care services and information from a distance. Telehealth usage has evolved from static "store-and-forward" applications in which information, such as radiologic images, is stored and then forwarded for diagnostic review or a second opinion. Today's clinicians are providing virtual visits in real time through secure, interactive video exchange. These telehealth visits address a wide range of issues, from urgent to chronic, from primary care to subspecialty consultation, and from initial diagnosis to follow-up and management.As the largest health care delivery platform in the United States, the primary care setting 1 offers great potential for expanding telehealth use. TeleThis article was externally peer reviewed.

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Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis

Odendaal

Watkins

Leon

et al. 2020

Cochrane Database of Systematic Reviews

228

198

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Perceived Barriers to and Facilitators of Patient-to-Provider E-Mail in the Management of Diabetes Care

Cited by 13 publications

References 8 publications

Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Electronic Consultation in Primary Care Between Providers and Patients: Systematic Review

Family Physicians Report Considerable Interest in, but Limited Use of, Telehealth Services

Health workers’ perceptions and experiences of using mHealth technologies to deliver primary healthcare services: a qualitative evidence synthesis

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