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Patient provider communication using secured web-messaging.

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  • http://eurpub.oxfordjournals.org/cgi/reprint/17/6/545
  • http://www.gw.utwente.nl/pcgr/en/emp/nijland/The PhD-project of Nicol focuses on the implementation and performance of interactive Web-based programs for supporting self-care management of patients. Particular emphasis is laid on patients with chronic conditions.
  • Pew Internet Website: http://www.pewinternet.org/Presentations/2008/Degrees-of-Access-(May-2008-data).aspx
  • The statements were based on previous studies about barriers and motivations regarding the use of e-consultation in primary care among early adopters [8–11,17–24] and referred to aspects with significant impact on e-consultation use, such as convenience, self-control, self-management of care and the use of different formats for self-control.
  • Examples of member org. : National Federation of Cancer Patients, The COPD Patient Association,the Dutch Diabetes Association, the Cardiovascular Diseases Association, the Dutch Muscular Diseases Federation,Association of Patients in Mental Health Care, the Skin Diseases Federation, the Dutch Association for Patients with Hearing Problems.
  • Probability that a difference or significant happened by chanceIs the probability that the null hypothesis is through (range 0-1) midpoint 0.05 about this point there is no significance.
  • Dependent variable is not continuous data and no normal distribution exists. The data scored from 1-5

Increasing the use of e-consultation in primary care Presentation Transcript

  • 1. CATCH-IT: Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation
    NicolNijland, Julia E.W.C. van Gemert-Pijnen, Henk Boer, Michaël F. Steehouder, Erwin R. Seydel, International Journal of Medical Informatics - October 2009 (Vol. 78, Issue 10, Pages 688-703, DOI: 10.1016/j.ijmedinf.2009.06.002)
    By: Marjan Moeinedin
    October 26, 2009
  • 2. Article information
    Research elements
    Background
    Objective
    Method
    Analysis
    Results
    Discussion
    Conclusion
    Questions to the authors
    Class discussion
    Table of Contents
    2
  • 3. Article Information
  • 4. This study was supported by The Federation of Patients and Consumer Organizations in the Netherlands.
    Article History:
    Received 12 February 2009
    Received in revised form 16 June 2009
    Accepted 20 June 2009
    Article history:
    4
  • 5. NicolNijland(PHD student, 2006-010)
    Department of Psychology and Communication of Health and Risk, Faculty of Behavioral Sciences, University of Twente, Enschede, The Netherlands.
    First Author
    5
  • 6. Research Elements
  • 7. In spite of the substantial increase in the use of Internet as a source for health information, the use of e-consultation remains relatively low. (Pew Internet website)
    Potential benefits of e-consultation:
    Increased access to care.
    Patients can ask questions from any place and at any time
    Increased self-management support for individuals with significant medical problems.
    e-consultation use can empower patients’ self-control skills and strengthen their autonomy
    Reduced costs while maintaining the same or achieving better quality of care.
    e-consultation can respond to an increasing demand for care in the aging society
    Background
    7
  • 8. The motivations for using two types of e-consultation provided in Netherlands was investigated
    Direct e-consultation:
    consulting a GP through secured e-mail.
    Indirect e-consultation:
    consulting a GP through secured email with intervention of a Web-based triage system.
    Background
    8
  • 9. To identify factors that can increase the use of e-consultation among non-users: patients with access to Internet, but with no prior e-consultation experience.
    Objective
    9
  • 10. On-line Survey instrument
    • Assessed the factors that could enhance e-consultation use among Dutch primary care patients with Internet access, but no experience with e-consultation.
    • 11. The survey was pre-tested by patients recruited through the Dutch Federation of Patients and Consumer Organizations.
    • 12. The survey covered 7main topics and contained
    a total of 45 items.
    Method
    10
  • 13. Topic 1: asked whether patients had experience with e-consultation (Yes/No).
    Topics 2–6 consisted of multiple statements, which could be answered on a 5-point scale ranging from strongly disagree (1) to strongly agree (5).
    Topic 2 (seven statements) examined possible barriers to using e-consultation.
    Topic 3 (ten statements) assessed patients’ demands regarding e-consultation.
    Survey Items
    11
  • 14. Topic 4 (seven statements) identified motivations for using e-consultation.
    Topics 5-6 (seven statements and eight statements) assessed the motivation for using two types of e-consultation: direct e-consultation and indirect e-consultation.
    Topic 7 questions were related to ’ socio-demographic and health-related characteristics, such as gender, age, education level, chronic use of medication, and frequency of seeing a GP.
    Survey Items (cont’d)
    12
  • 15.
    • Primary target group for e-consultation:
    • 16. 18 years of age and above.
    • 17. Patients with various chronic conditions and basic Internet skills who have visited health-related websites.
    • 18. Participants were recruited through banners on frequently visited websites of 26 well-trusted patient organizations.
    • 19. All organizations were members of the Dutch Federation of Patients and Consumer Organizations.
    • 20. By clicking on a banner patients were automatically linked to the online survey, which was available for a period of 11 weeks.
    Participants Recruitment
    13
  • 21. SPSS version 13.0
    Descriptive statistics, mean, sum of scores were computed for all constructs .
    Internal consistency of all constructs was satisfactory
    Cronbach’s = 0.64 to 0.84.
    F-tests (one-way ANOVA) were used to identify significant differences between independent variables of interest.
    Linear regression models were used to predict the dependent variable ‘motivation for using e-consultation’ (mean score of questions 4–6, Cronbach’s ˛ = .86).
    Data analysis
    14
  • 22. Independent predictors included:
    barriers towards e-consultation
    demands regarding e-consultation
    socio-demographic and health-related characteristics
    age,
    education level
    medication use
    frequency of seeing a GP
    Two-tailed significance was considered at the p < .05 level.
    Data analysis (cont’d)
    15
  • 23. Study participants
    Of the total sample (n = 1706), 1066 were eligible
    163 patients (9.6%) had experience with e-consultation.
    Of the remaining 1543 patients (90.4%) who had no prior e-consultation experience, only 1066 patients were eligible for the analysis.
    Patients who had filled out only 1 question were excluded.
    n varied since patients could skip questions.
    Results
    16
  • 24. Results (cont’d)
    Table 1: Characteristics of participants
    Highlights of Table 1:
    (62.4%) Female
    (70.2%) frequent GPs visitors
    The mean age was 49 years old (SD = 13.5)
    50% of the patients were highly educated (50.9%).
    Highlights of table 1
    17
  • 25. The most prominent reasons for not using e-consultation:
    65% were not aware of the existence of e-consultation services
    56% preferred to see a doctor
    53% had limited access to e-consultation services, because their GP did not provide e-consultation
    Computer or Internet skills were not expected to be a problem
    66.1% did not know whether the use of e-consultation is refunded by their insurer
    Results: Barriers towards e-consultation
    18
  • 26. Barriers towards e-consultation (%)
    19
  • 27. The top priority regarding demands for e-consultation:
    98% agreed on getting a quick response
    63.9 % agreed that it was important for their GP to answer their question
    all other demands were almost equally important to the patients
    Results: Demands regarding e-consultation
    20
  • 28. Demands regarding e-consultation (%)
    21
  • 29. Patients were fairly willing to use e-consultation:
    92% to have the ability to contact a GP regardless of time
    81.3% to have the ability to contact a GP regardless of place
    86.3% to have the possibility to formulate questions undisturbed
    Results: Motivations for using e-consultation
    22
  • 30. Motivations for using e-consultation in general (%)
    23
  • 31.
    • Participants were asked about two types of e-consultation provided in Netherlands:
    • 32. Direct - consulting a GP through secured email
    • 33. In-direct – consulting a GP through secured e-mail with intervention of a triage mechanism for advice on whether it is necessary to see a doctor and for self-care advice
    Results: Motivations for using e-consultation
    24
  • 34. motivations for using direct e-consultation:
    88.2% the possibility to ask additional questions after a visit to the doctor
    78.4% the possibility to ask questions about medication use
    55.5% Getting advice on how to handle a health problem
    45.9% asking questions about the costs and payment of treatments
    The last two points were less of a motivation to use e-consultation.
    Results: Motivations for using e-consultation
    25
  • 35. Motivations for using direct e-consultation (%)
    26
  • 36. motivations for using indirect e-consultation:
    Agreement on the statements was fairly high overall
    87.8 % to decide if a visit to the GP was necessary
    83.7% to get self-care advice
    80.3% to reduce uncertainty
    47% to ask questions anonymously
    41% felt no need for anonymous inquiries
    Results: Motivations for using e-consultation
    27
  • 37. Motivations for using indirect e-consultation (%)
    28
  • 38.
    • Regression analysis showed
    • 39. high correlation between demands for using e-consultation and patients’ characteristics
    • 40. The motivation for using e-consultation increased
    • 41. as more demands were satisfied such as getting a timely response
    • 42. Of all patient characteristics
    • 43. education level and age were the strongest predictors of the motivations for using e-consultation
    • 44. The less-educated and elderly patients seemed more strongly motivated to use the service than the more highly educated and younger patients
    Results: Main drivers for e-consultation
    29
  • 45. Bivariate correlations and regression analyses: predictors associated with ‘motivations for using e-consultation
    30
  • 46. Distinct patient groups were compared regarding
    age
    education level
    chronic use of medication
    frequency of GP visits
    Focus was on the patient groups that
    have a greater change of being left behind
    could benefit from e-consultation because of their increasing demand for care
    Results: Comparison of patient groups on barriers,demands and motivations regarding e-consultation
    31
  • 47. Distinguished patient groups (n = 1066)
    32
  • 48.
    • Elderly patients appeared to have
    • 49. lower Internet skills
    • 50. greater concerns about the costs of using e-consultation
    • 51. Less-educated patients
    • 52. were less aware of the existence of e-consultation services
    • 53. had lower Internet skills
    • 54. had more doubts about the reliability and privacy of information
    • 55. Face-to-face contact was
    • 56. preferred more strongly by the chronic medication users
    • 57. The frequent GP visitors had
    • 58. stronger preference to visit a doctor
    Results: Comparison of patient groups on perceived barriers towards e-consultation
    33
  • 59. Comparison of patient groups on perceived barriers towards e-consultation
    34
  • 60.
    • the target patient group (with no e-consultation experience) had a greater e-consultation demands than other groups
    • 61. The elderly patients
    • 62. had stronger demands, to obtain evidence-based answers from their caregivers
    • 63. The less-educated patients preferred
    • 64. to receive instructions about e-consultation use
    • 65. to receive information about the possibilities and restrictions of e-consultation
    • 66. to use e-consultation free of charge
    • 67. The chronic medication users had a greater desire
    • 68. to obtain an answer from their own GP
    • 69. to have their e-consultation stored in their medical record
    • 70. Frequent GP visitors preferred
    • 71. To be informed about the possibilities and restrictions of e-consultation
    Results: Comparison of patient groups on demands regarding e-consultation
    35
  • 72. Comparison of patient groups on demands regarding e-consultation
    36
  • 73. Significant differences were found between the patient groups’ motivation to use e-consultation.
    The elderly patients, the less-educated patients’ and the chronic medication users were significantly more motivated to use e-consultation than their counterparts.
    Results: Comparison of patient groups on motivations to use e-consultation
    37
  • 74. Comparison of patient groups on motivations to use e-consultation in general
    38
  • 75. The results on direct e-consultation showed
    elderly and less-educated patients were significantly more motivated
    e-consultation enabled them to ask questions about the costs and payment of a treatment
    to seek advice about certain health problems
    The chronic medication users were also more motivated to use e-consultation, especially to pass on their medical data
    Results: Comparison of patient groups on motivations to use direct e-consultation
    39
  • 76. Comparison of patient groups on motivations to use direct e-consultation
    40
  • 77. The results on indirect e-consultation indicated that
    the less-educated patients were more motivated than the more highly educated patients to use a Web-based triage application, especially for uncertainty reduction.
    Results: Comparison of patient groups on motivations to use indirect e-consultation
    41
  • 78. Comparison of patient groups on motivations to use indirect e-consultation
    42
  • 79. The results of the study showed
    that 70% of the study population, patients with no e-consultation experience (n = 1066), were frequent GP visitors
    e-consultation may be especially beneficial for these patients with a higher demand for care
    it can help them decide whether it is necessary to see a doctor and teach them self-care techniques in order to prevent unnecessary encounters
    The most prominent barriers towards e-consultation were:
    unawareness of the existence of e-consultation
    e-consultation not being provided by a GP
    the preference to see a doctor
    Discussion
    43
  • 80. Education and examination of user expectations can provide a solution for these barriers, for both patients and caregivers alike.
    Patients are dependent on a GPs’ provision of e-consultation. Therefore, it is important to advise caregivers on the mutual benefits of e-consultation, its consequences and implementation into regular practice.
    It is also important for GPs to ask their patients about e-consultation since patients are unlikely to request electronic GP access, simply because they are unaware of the option.
    Also, non-users of e-consultation may have no clear ideas or assumptions about the benefits and disadvantages of e-consultation.
    Discussion (cont’d)
    44
  • 81. The results demonstrated that
    non-users were fairly motivated to use e-consultation, but only under certain conditions
    certain patient groups, such as less-educated patients, elderly patients and chronic users of medication were especially motivated to use e-consultation but also perceived many barriers towards e-consultation
    The elderly patients, perceived a stronger lack of Internet skills than younger patients
    the less-educated patients were less aware of the existence of e-consultation than the more highly educated patients
    Discussion (cont’d)
    45
  • 82. Non-users might have a limited view on the possibilities of e-consultation for self-care.
    Future research could focus on the motivations of early adopters in comparison to the motivations of non-users.
    Another did not reflect on motivations, demands and barriers of patients without access to a computer or Internet or patients with GPs without e-consultation services.
    The study was directed solely at Internet users, because this population had the potential to use e-consultation in the near future
    Limitations of this study
    46
  • 83. Increase in use of e-consultation will occur through solving existing barriers among non-users and through addressing patients’ demands, preferences and skills when developing e-consultation systems.
    Patient profiles should be taken into account.
    Special attention should be paid to patients who can benefit the most from e-consultation.
    In a patient centered healthcare system, it is expected that patient expectations and demands will be a major force in driving the use of electronic communication.
    Conclusions
    47
  • 84. Nicol Nijland, Julia E.W.C. van Gemert-Pijnen, Henk Boer, Michaël F. Steehouder, Erwin R. Seydel, International Journal of Medical Informatics - October 2009 (Vol. 78, Issue 10, Pages 688-703, DOI: 10.1016/j.ijmedinf.2009.06.002)
    Reference
    48
  • 85. There was no mentioning of REB in the paper. Was there a need for obtaining patients informed consent in an online survey study?
    How was the survey developed? Was it validated? Authors did not comment on the development and validation of the online survey.
    How did the authors handle incomplete questioners?
    How did the authors handle duplicated surveys? Was there a method to prevent that?
    Was it beneficial to do a comparisons between the excluded patients and included patients in the study?
    Why should a patient use e-consultation if a telehealth service exists?
    Reported sample size in tables and graphs revealed that between 200-300 out of 1066 patients skipped at least one question. Could this large number of missing values severely biased the statistical results? How did authors account for that?
    Questions for the authors
    49
  • 86. Class discussion
    50
  • 87. Thank you
    51