Email and Texts to Doctors: Not Just for High-Income PatientsWednesday, April 17, 2013
Low-income patients served by “safety-net” community health centers want to communicate with their doctors via email or text or are already doing so, according to a new study in the Journal of General Internal Medicine. Despite reports of a ‘digital divide’, an inequality in Internet access for people of low socioeconomic status, a survey of community health center patients found that 60 percent were current email users.
“Safety net patients have no intention of being left behind by the digital revolution in health,” said lead study author Adam Schickedanz, M. D. of the University of California San Francisco’s department of pediatrics. Converting many face-to-face encounters into more convenient and efficient electronic encounters just makes sense, he said.
Schickedanz and his colleagues sought to analyze “access to, interest in, and attitudes toward internet-based communication in an ethnically, economically, and linguistically diverse group of patients from a large urban safety net clinic network”, the San Francisco Community Health Network.
“A huge influx of new patients coming into community health clinics without corresponding staffing increases resulted in a big push to find ways to expand access,” he said. “We thought that since this trend is coming down the pipeline nationally with the Affordable Care Act, we might find ways to solve the problem on a bigger scale.”
The study found that 60 percent of patients—from all walks of life—used email in general, 71 percent wanted to use electronic communication to converse with their health care providers and 19 percent had used email informally for that purpose.
Previous research shows the value of communications between patient and provider via email or patient portals with secure Web messaging, the authors said. Patients’ language, literacy level, and experience with communication technology all remain variables in the equation.
“The Internet is a social equalizer bringing all people together, and online communication is a convenient no-cost platform for care,” said Joseph E. Scherger, M.D., M.P.H., vice president of primary care and academic affairs at the Eisenhower Medical Center Annenberg Center for Health Sciences in Rancho Mirage, Calif. “Anyone can use a public library to communicate and search the Web. This study shows that safety net populations can be cared for using online communication as a bridge between providers and patients.”
“A surprising finding was the impressive strength of electronic communication utilization—providers in public health clinics were shocked and had no idea so many patients would be interested,” said Schickedanz. “Providers realized they could manage ‘Mr. Smith’s’ diabetes control from home, that he could log glucose levels and send them in, as opposed to having him travel an hour each way to come in and get vital signs checked. Overall, it’s been a nice moment—to learn what can be done for patients and providers alike.”
While some face-to-face encounters could be avoided, plenty of others—probably the majority—should still be in-person because they require a physical exam or in-depth conversation that would be challenging through patient portals, he said. But, he added, in “under-resourced settings,” technology can lighten the heavy load on providers and improve both efficiency and quality.