Use of the Internet Communication with Health Care Provider

Discussion

Despite over a decade of research and the availability of guidelines for use of Internet-based communication by health care providers, the number of health care consumers using online patient-provider communication is still far below estimates of the number who would prefer to do so. Though data from HINTS suggest that use is slowing increasing, diffusion of online patient-provider communication is occurring at a pace far slower than diffusion of Internet use in general.
Thus, the question remains: Why is the overall prevalence of online communication with health care providers so low? While health care consumers and health care providers express concerns about communicating online, ratings of satisfaction and predictions about impact on health care quality regarding Internet-based communication have been generally favorable among both health care consumers and health care providers. Therefore, use of online patient-provider communication will likely not significantly increase through efforts to change the primarily positive attitudes of health care consumers or health care providers, but rather, through changes in policies related to health care delivery and through development of systems that prioritize usability. Recent increased availability and adoption of online personal health records and electronic health records will likely affect the prevalence of online patient-provider communication, as will policies at the state and federal levels designed to promote diffusion of health information technology. Continued implementation of policies that provide an architecture of support for online patient-provider communication and that address issues related to consumer and health care provider preferences, system interoperability, data security, and health care costs will be critical for maximizing the availability, adoption, and effectiveness of Internet-based communication between health care consumers and health care providers.
Associations between Internet users’ sociodemographic and health-related characteristics and use of online patient-provider communication reveal insights regarding who may be taking the lead with online health care provider communication and who may be left behind. In 2003, Internet users with high levels of education were more likely to have communicated online with an health care provider, consistent with previous studies. That education was nonsignificant in 2005 may suggest that health care consumers’ level of education is less of a barrier to communicating online with health care providers as the prevalence of online patient-provider communication increases. Similarly, though Internet users residing in non-metro counties were less likely to have used online patient-provider communication in 2003, metropolitan statistical area was not associated with use in 2005. Deeper penetrance of high-speed Internet access into more rural areas may have decreased, over time, the degree to which location prevented online communication with health care providers. In both years, indicators of poorer health status (poor/fair self-reported health status, personal cancer history) were associated with online health care provider communication, suggesting that Internet users with more medical problems or who are more engaged with the health care system due to a significant medical history may be more “hooked in” to Internet-based health communication resources or may have more a frequent need to use them. Finally, in 2005, women were more likely to use online patient provider communication compared to men. This result is consistent with findings that online women are more likely to search specifically for health information compared to men and that higher percentages of women use the Internet for interpersonal communication related to health (eg, use of online support groups or health-based chat rooms).
We did not observe associations between online communication with health care providers and characteristics such as race/ethnicity or annual income that have been documented in other studies as evidence of a “digital divide”. Nonetheless, research and policy should continue to address groups potentially affected by the digital divide to ensure that advances in health information technology benefit all health care consumers. Finally, our results were not consistent with previous studies that observed younger Internet users to be more likely to engage in online communication with health care providers, suggesting a potential growth in comfort with online communication among Internet users of all ages.