Singh Hardeep, Fox Sarah A, Petersen Nancy J, Shethia Anila, Street Richard L
Houston VA Health Services Research and Development (HSR&D) Center of Excellence, Michael E DeBakey Veterans Affairs Medical Center, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.
J Med Internet Res. 2009 Jun 16;11(2):e18. doi: 10.2196/jmir.1143.
Recent evidence indicates increased access to and use of Internet and non-healthcare-related email by older patients. Because email adoption could potentially reduce some of the disparities faced by this age group, there is a need to understand factors determining older patients' enthusiasm to use email to communicate with their physicians. Electronic mail (email) represents a means of communication that, coupled with face-to-face communication, could enhance quality of care for older patients.
Test a model to determine factors associated with older patients' enthusiasm to use email to communicate with their physicians.
We conducted a secondary data analysis of survey data collected in 2003 for two large, longitudinal, randomized controlled trials. Logistic-regression models were used to model the dichotomous outcome of patient enthusiasm for using email to communicate with their physicians. Explanatory variables included demographic characteristics, health status, use of email with people other than their physician, characteristics of the physician-patient relationship, and physician enthusiasm to use email with patients.
Participants included a pooled sample of 4059 patients over 65 years of age and their respective physicians (n = 181) from community-based practices in Southern California. Although only 52 (1.3%) patient respondents reported that they communicated with their physician by email, about half (49.3%) expressed enthusiasm about the possibility of using it. Odds of being enthusiastic decreased with increased age (by 0.97 for each year over 66) but were significantly higher in African Americans (OR = 2.1, CI = 1.42 - 3.06), Hispanics (OR = 1.6, CI = 1.26 - 2.14) and men (OR = 1.3, CI = 1.1 - 1.5). A perception of better communication skills of their physician, lower quality of interaction with physician in traditional face-to-face encounters, and physician enthusiasm to use email with patients were significantly associated with an enthusiasm to use email. Patients who did not use email at all were less enthusiastic compared to those who used email for other reasons. Half of the physician respondents were not enthusiastic about communicating with patients using email.
Despite perceived barriers such as limited access to the Internet, older patients seem to want to use email to communicate with their physicians.
近期证据表明，老年患者使用互联网及与医疗保健无关的电子邮件的机会和频率有所增加。由于采用电子邮件有可能减少该年龄组面临的一些差异，因此有必要了解决定老年患者使用电子邮件与医生沟通积极性的因素。电子邮件是一种沟通方式，与面对面沟通相结合，可以提高老年患者的护理质量。
测试一个模型，以确定与老年患者使用电子邮件与医生沟通积极性相关的因素。
我们对2003年为两项大型纵向随机对照试验收集的调查数据进行了二次数据分析。使用逻辑回归模型对患者使用电子邮件与医生沟通的积极性这一二分结果进行建模。解释变量包括人口统计学特征、健康状况、与医生以外的人使用电子邮件的情况、医患关系特征以及医生使用电子邮件与患者沟通的积极性。
参与者包括来自南加州社区医疗机构的4059名65岁以上患者及其各自医生（n = 181）的汇总样本。虽然只有52名（1.3%）患者受访者表示他们通过电子邮件与医生沟通，但约一半（49.3%）的人对使用电子邮件表示出积极性。积极性的几率随年龄增长而降低（66岁以上每增加一岁降低0.97），但非裔美国人（OR = 2.1，CI = 1.42 - 3.06）、西班牙裔（OR = 1.6，CI = 1.26 - 2.14）和男性（OR = 1.3，CI = 1.1 - 1.5）的积极性几率显著更高。认为医生沟通技巧更好、在传统面对面就诊中与医生互动质量较低以及医生使用电子邮件与患者沟通的积极性与使用电子邮件的积极性显著相关。与因其他原因使用电子邮件的患者相比，完全不使用电子邮件的患者积极性较低。一半的医生受访者对使用电子邮件与患者沟通不感兴趣。
尽管存在诸如互联网接入有限等明显障碍，但老年患者似乎希望使用电子邮件与医生沟通。
