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Kaiser Study Finds That Patients Prefer E-Mail

Researchers for the California health system find that chronic care patients want to use mHealth as an initial point of contact with their doctors - and that it may improve their care management and outcomes.

By Eric Wicklund

- A four-year-old study conducted by Kaiser Permanente has found that patients prefer their first contact with a doctor to be via e-mail – and that it improves the care management process.

The survey of more than 1,000 northern California residents with a chronic condition in the KP network, conducted in 2011 and recently detailed in the American Journal of Managed Care, found that 83 percent of patients who spend at least $60 in deductibles or co-pays prefer e-mail as the first point of contact, Among patients with less than $60 in deductibles or co-pays, that percentage is still 63 percent.

The findings suggest consumers who spend more out of their own pocket for office visits would prefer to chat with a doctor when it’s convenient for them, and that such correspondences reduced their need for a phone call or office visit.

"We found that a large proportion of patients used e-mail as their first method of contacting healthcare providers across a variety of health-related concerns," Mary E. Reed, DrPH,, staff scientist with the Kaiser Permanente Division of Research in Oakland, Calif., and the study's lead author, said in a press release. "As more patients gain access to online portal tools associated with electronic health records, e-mails between patients and providers may shift the way that healthcare is delivered and also impact efficiency, quality and health outcomes."

The survey, considered one of the first to examine how secure e-mails can affect patient behaviors, found that two-thirds of the respondents reported no change in their overall health when exchanging in-person visits for e-mail correspondence. More importantly, one-third of those surveyed said the secure e-mails actually improved their overall health.

In addition, of those surveyed, 36 percent said they were able to reduce in-person visits, while 42 percent said they were able to cut back on phone calls. This suggests that secure e-mails might help patients who typically have problems accessing healthcare because of cost, convenience or travel issues. Among patients with a chronic condition such as asthma, diabetes or COPD, this population tends to account for a proportionate share of avoidable healthcare costs.

“In addition to the cost-sharing associated with a doctor’s office visit, patients often face additional barriers and costs to seeking in-person care, such as difficulty getting time off from work or arranging transportation or childcare,” the report stated. “The convenience of e-mail may reduce these barriers to accessing care. Also, our finding of higher rates of patients using secure messaging as their first method of contact when facing higher out-of-pocket costs for in-person care may signal changes in patients’ care-seeking patterns that could become increasingly common as patient cost-sharing levels continue to grow and the ability to communicate with providers electronically becomes more widespread.”

The study did benefit from the fact that Kaiser Permanente operates one of the more active patient portals in the nation. In 2014, alone, more than 20 million secure e-mails were sent to providers through the My Health Manager portal.

Researchers said the impact of patient use of portals hasn’t been fully studied, but their research points to the conclusion that the better the portal, the better the outcome.

“Some patients explained that issues such as lab orders, medication changes, and patient questions could be addressed by e-mail and could reduce the need for an in-person visit,” the report noted. “In addition, patients noted that greater information availability and engagement in their own care improved the management of their conditions and overall health. Overall, we found that patients regularly used secure messages to initiate conversations with their providers across a wide range of types of health questions and concerns and many report that these exchanges improved their health.”

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