Dataset Information

Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys.

ABSTRACT: BACKGROUND:Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who-among both patients and clinicians-is using secure messaging. OBJECTIVE:Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians, and to explore the clinical practice and physician characteristics and patient sociodemographic characteristics associated with the use of secure messaging. METHODS:We conducted regression analyses to identity statistical associations between self-reported secure messaging use and access, and the patient, practice, and physician characteristics from the National Health Interview Survey (NHIS) and the National Ambulatory Medical Care Survey (NAMCS). The NHIS data collected between 2013 and 2018, with approximately 150,000 adult individuals, were used to evaluate patient characteristics associated with email communication with clinicians. The NAMCS data included 7340 physicians who reported on secure messaging use between 2013 and 2016 and provided context on physician specialty, use of certified health information technology (IT), and practice size and ownership associated with secure messaging access and use. RESULTS:By 2016, two-thirds of ambulatory care visits were conducted by a physician who reported using secure messaging, up from 40.70% in 2013. The percentage of US residents who reported sending an email to their clinician, however, only increased from 7.22% to 16.67% between 2013 and 2018. We observed a strong positive association between certified health IT use and secure messaging use (odds ratio [OR] 11.46, 95% CI 7.55-17.39). Individuals who were black, had lower levels of education, had Medicaid or other public payer insurance, or those who were uninsured had reduced odds for using email to communicate with clinicians. No differences were observed in secure messaging use based on physician specialty, but significant differences were observed by practice size (OR 0.46, 95% CI 0.35-0.60 in solo practices vs nonsolo practices) and practice ownership (P<.001 for the different categories). CONCLUSIONS:This study is the first to use two large nationally representative surveys to produce longitudinal estimates on the access and use of patient-clinician email communication in the United States. The survey findings complement each other: one provides the patient perspective of their use and the other indicates potential patient access to secure messaging based on the use of the functionality by the physicians providing treatment. This study provides nationally representative data on the characteristics of patients and physicians who have access to and are using secure messaging. This information can be used to target interventions to promote adoption and use of secure messaging.

SUBMITTER: Heisey-Grove DM

PROVIDER: S-EPMC7229528 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys.

Heisey-Grove Dawn M DM Carretta Henry J HJ

Journal of medical Internet research 20200501 5

<h4>Background</h4>Emails securely exchanged between patients and clinicians offer the promise of improved access to care and indirectly improved health outcomes. Yet research to date is mixed on who-among both patients and clinicians-is using secure messaging.<h4>Objective</h4>Using data from two large nationally representative cross-sectional surveys, this study aimed to compare the prevalence of secure messaging use among patients and their access to the functionality through their physicians ...[more]

PMID: 32356775

Similar Datasets

Project description:BackgroundThe perinatal period is a vulnerable time, with one in five women experiencing mental health problems. Antenatal and postnatal appointments are key contact points for identifying women in need of support. Since 2014, the UK National Institute for Health and Care Excellence (NICE) has recommended that all women be asked about their mental health at their antenatal booking appointment and early in the postnatal period. The aim of this study was to assess the proportions of women who reported being asked about their mental health during the perinatal period across consecutive national maternity surveys (NMS) in England and to evaluate sociodemographic disparities in who was asked.MethodsSecondary analysis was performed on cross-sectional data from the NMS in 2014-2020. In each survey, women reported whether they had been asked about their mental health antenatally (during their booking appointment) and postnatally (up to six months after giving birth). The proportions of women in each survey who reported being asked about their mental health were calculated and compared according to key sociodemographic characteristics and across survey years. Logistic regression was conducted to identify disparities in who was asked.ResultsThe proportion of women who reported being asked about their mental health antenatally increased from 80.3% (95%CI:79.0-81.5) in 2014 to 83.4% (95%CI:82.1-84.7) in 2020, yet the proportion of women who reported being asked postnatally fell from 88.2% (95%CI:87.1-89.3) in 2014 to 73.7% (95%CI:72.2-75.2) in 2020. Ethnic minority women (aOR range:0.20 ~ 0.67) were less likely to report being asked about their mental health antenatally and postnatally across all surveys compared to White women. Women living in less socioeconomically advantaged areas (aOR range:0.65 ~ 0.75) and women living without or separately from a partner (aOR range:0.61 ~ 0.73) were also less likely to report being asked about their mental health, although there was less consistency in these disparities across the antenatal and postnatal periods and across surveys.ConclusionsDespite NICE recommendations, many women are still not asked about their mental health during the perinatal period, particularly after giving birth. Women from ethnic minority backgrounds are less likely to be asked and these disparities have persisted over time.

Project description:ObjectivesThe UK faces major problems in retaining general practitioners (GPs). Scotland introduced a new GP contract in April 2018, intended to better support GPs. This study compares the career intentions and working lives of GPs in Scotland with GPs in England, shortly after the new Scotland contract was introduced.Design and settingComparison of cross-sectional analysis of survey responses of GPs in England and Scotland in 2017 and 2018, respectively, using linear regression to adjust the differences for gender, age, ethnicity, urbanicity and deprivation.Participants2048 GPs in Scotland and 879 GPs in England.Main outcome measuresFour intentions to reduce work participation (5-point scales: 1='none', 5='high'): reducing working hours; leaving medical work entirely; leaving direct patient care; or continuing medical work but outside the UK. Four domains of working life: job satisfaction (7-point scale: 1='extremely dissatisfied', 7='extremely satisfied'); job stressors (5-point-scale: 1='no pressure', 5='high pressure); positive and negative job attributes (5-point scales: 1='strongly disagree', 5='strongly agree').ResultsCompared with England, GPs in Scotland had lower intention to reduce work participation, including a lower likelihood of reducing work hours (2.78 vs 3.54; adjusted difference=-0.52; 95% CI -0.64 to -0.41), a lower likelihood of leaving medical work entirely (2.11 vs 2.76; adjusted difference=-0.32; 95% CI -0.42 to -0.22), a lower likelihood of leaving direct patient care (2.23 vs 2.93; adjusted difference=-0.37; 95% CI -0.47 to -0.27), and a lower likelihood of continuing medical work but outside of the UK (1.41 vs 1.61; adjusted difference=-0.2; 95% CI -0.28 to -0.12). GPs in Scotland reported higher job satisfaction, lower job stressors, similar positive job attributes and lower negative job attributes.ConclusionFollowing the introduction of the new contract in Scotland, GPs in Scotland reported significantly better working lives and lower intention to reduce work participation than England.

Project description:ObjectiveTo investigate the determinants of willingness and practice of physicians' online medical services (OMS) uptake based on social ecosystem theory, so as to formulate OMS development strategies.DesignCross-sectional survey.SettingResearch was conducted in two comprehensive hospitals and two community hospitals in Jiangsu, China, and the data were gathered from 1 June to 31 June 2020.ParticipantsWith multistage sampling, 707 physicians were enrolled in this study.Outcome measureDescriptive statistics were reported for the basic characteristics. χ2 test, Mann-Whitney U test and Spearman's correlation analysis were used to perform univariate analysis. Linear regression and logistic regression were employed to examine the determinants of physicians' OMS uptake willingness and actual uptake, respectively.ResultsThe mean score of the physicians' OMS uptake willingness was 17.33 (range 5-25), with an SD of 4.39, and 53.3% of them reported having conducted OMS. In the micro system, factors positively associated with willingness included holding administrative positions (b=1.03, p<0.05), OMS-related awareness (b=1.32, p<0.001) and OMS-related skills (b=4.88, p<0.001); the determinants of actual uptake included holding administrative positions (OR=2.89, 95% CI 1.59 to 5.28, p<0.01), OMS-related awareness (OR=1.90, 95% CI 1.22 to 2.96, p<0.01), OMS-related skills (OR=2.25, 95% CI 1.35 to 3.74, p<0.01) and working years (OR=2.44, 95% CI 1.66 to 3.59, p<0.001). In the meso system, the hospital's incentive mechanisms (b=0.78, p<0.05) were correlated with willingness; hospital advocated for OMS (OR=2.34, 95% CI 1.21 to 4.52, p<0.05), colleagues' experiences (OR=3.81, 95% CI 2.25 to 6.45, p<0.001) and patients' consultations (OR=2.93, 95% CI 2.02 to 4.25, p<0.001) were determinants of actual uptake. In the macro system, laws and policies were correlated with willingness (b=0.73, p<0.05) and actual uptake (OR=1.98, 95% CI 1.31 to 2.99, p<0.01); media orientation was also associated with willingness (b=0.74, p<0.05).ConclusionMultiple determinants influence physicians' OMS application. Comprehensive OMS promotion strategies should be put forward from multidimensional perspectives including the micro, meso and macro levels.

Project description:We examined the relationship between in vivo estimates of tau deposition as measured by 18F-AV-1451 tau positron emission tomography imaging and cross-sectional cortical thickness, as well as rates of antecedent cortical thinning measured from magnetic resonance imaging in individuals with and without evidence of cerebral amyloid in 63 participants from the Alzheimer's Disease Neuroimaging Initiative study, including 32 cognitively normal individuals (mean age 74 years), 27 patients with mild cognitive impairment (mean age 76.8 years), and 4 patients diagnosed with Alzheimer's disease (mean age 80 years). We hypothesized that structural measures would correlate with 18F-AV-1451 in a spatially local manner and that this correlation would be stronger for longitudinal compared to cross-sectional measures of cortical thickness and in those with cerebral amyloid versus those without. Cross-sectional and longitudinal estimates of voxelwise atrophy were made from whole brain maps of cortical thickness and rates of thickness change. In amyloid-?-positive individuals, the correlation of voxelwise atrophy across the whole brain with a summary measure of medial temporal lobe (MTL) 18F-AV-1451 uptake demonstrated strong local correlations in the MTL with longitudinal atrophy that was weaker in cross-sectional analysis. Similar effects were seen in correlations between 31 bilateral cortical regions of interest. In addition, several nonlocal correlations between atrophy and 18F-AV-1451 uptake were observed, including association between MTL atrophy and 18F-AV-1451 uptake in parietal lobe regions of interest such as the precuneus. Amyloid-?-negative individuals only showed weaker correlations in data uncorrected for multiple comparisons. While these data replicate previous reports of associations between 18F-AV-1451 uptake and cross-sectional structural measures, the current results demonstrate a strong relationship with longitudinal measures of atrophy. These data support the notion that in vivo measures of tau pathology are tightly linked to the rate of neurodegenerative change.

Project description:BackgroundAt the onset of the COVID-19 pandemic general practitioners complained about feeling uninformed and lacking a sufficient flow of information from the local health authorities. Secure instant messaging describes a digital, chat-based form of communication, enabling ambulatory care providers to connect in real-time and share information across medial sectors. KomPan, a proof-of-concept study, established a secure instant messaging structure in two model regions in Germany to improve communication between general practitioners and local health authorities via an additional communication pathway. This paper presents results of a qualitative user survey.MethodsWe recruited general practitioners (n = 43) and staff of local health authorities (n=10) in two Hessian model regions for using the secure instant messaging (SIM) app of the Famedly GmbH, starting in December 2020 (2nd COVID-19 wave). We asked participants to share their usage experiences after a usage time of multiple months. In guided telephone interviews, we primarily asked how communication between the two user groups had changed while using secure instant messaging. The interviews were transcribed verbatim and analysed using thematic analysis.ResultsWe conducted ten interviews with general practitioners and two with staff of the participating local health authorities. Using our SIM-based platform promoted professional exchange between general practitioners. In contrast, the app had little impact on communication between local health authorities and general practitioners. Opposing expectations and usage patterns of the two user groups, among other reasons, probably led to a reduced direct trans-sectoral communication via secure instant messaging.ConclusionEstablishing local chat groups for general practitioners was welcomed, especially during the pandemic situation, to improve professional exchange while experiencing challenging working conditions. To use secure instant messaging effectively for trans-sectoral communication a more comprehensive approach seems to be needed, such as digitalisation of institutional communication structures and improved networks of local healthcare providers.

Dataset Information

Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys.

Publications

Disparities in Secure Messaging Uptake Between Patients and Physicians: Longitudinal Analysis of Two National Cross-Sectional Surveys.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets