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How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study.

ABSTRACT: OBJECTIVE:Email consultations have become part of everyday doctor-patient communication in many countries. The objective of this study is to investigate how patients and general practitioners (GPs) perceive the communicative advantages and disadvantages of access via email consultation drawing on a media-theoretical perspective. DESIGN:We analysed qualitative interview data from general practices in Denmark to identify salient themes. PARTICIPANTS:Our data set consists of semi-structured interviews with 30 patients and 23 GPs. The data were collected from February 2016 to September 2019. RESULTS:The following themes emerged: (1) lower contact threshold, (2) accessing a new interaction space and (3) access to access. From the patients' perspective, email consultations provided more convenient contact with their GP. From the GPs' perspective, email consultations facilitated contact with patients whom they otherwise rarely saw, but also resulted in overuse and inappropriate use. Patients and GPs considered email consultations as inviting new interactions, facilitating also communication about emotional and sensitive issues. Both patients and GPs experienced email consultations as a way in which patients could achieve easier access to face-to-face consultations (access to access). CONCLUSION:Drawing on a media perspective, this study adds knowledge of how the potentials of the medium of email consultations are perceived by GPs and patients. Email consultations do not simply extend existing forms of contact and consultation (face-to-face and telephone); they produce a new communication space with its own possibilities which result in new practices. With increasing use of email consultations, there may be challenges involved in transferring GP-patient communication to the written medium.

SUBMITTER: Gronning A

PROVIDER: S-EPMC7592270 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study.

Grønning Anette A Assing Hvidt Elisabeth E Nisbeth Brøgger Matilde M Fage-Butler Antoinette A

BMJ open 20201026 10

<h4>Objective</h4>Email consultations have become part of everyday doctor-patient communication in many countries. The objective of this study is to investigate how patients and general practitioners (GPs) perceive the communicative advantages and disadvantages of access via email consultation drawing on a media-theoretical perspective.<h4>Design</h4>We analysed qualitative interview data from general practices in Denmark to identify salient themes.<h4>Participants</h4>Our data set consists of s ...[more]

PMID: 33109668

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Project description:BackgroundIncreasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations.ObjectiveThis study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients.MethodsWe conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation.ResultsWe obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation.ConclusionsMost cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.

Project description:BACKGROUND:Patient-reported measures are increasingly recognized as important predictors of clinical outcomes in peritoneal dialysis (PD). We sought to understand associations between patient-reported perceptions of the advantages and disadvantages of PD and clinical outcomes. METHODS:In this cohort study, 2760 PD patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) completed a questionnaire on their PD experience, between 2014 and 2017. In this questionnaire, PDOPPS patients rated 17 aspects of their PD experience on a 5-category ordinal scale, with responses scored from - 2 (major disadvantage) to + 2 (major advantage). An advantage/disadvantage score (ADS) was computed for each patient by averaging their response scores. The ADS, along with each of these 17 aspects, were used as exposures. Outcomes included mortality, transition to hemodialysis (HD), patient-reported quality of life (QOL), and depression. Cox regression was used to estimate associations between ADS and mortality, transition to HD, and a composite of the two. Logistic regression with generalized estimating equations was used to estimate cross-sectional associations of ADS with QOL and depression. RESULTS:While 7% of PD patients had an ADS < 0 (negative perception of PD), 59% had an ADS between 0 and < 1 (positive perception), and 34% had an ADS ≥1 (very positive perception). Minimal association was observed between mortality and the ADS. Compared with a very positive perception, patients with a negative perception had a higher transition rate to HD (hazard ratio [HR] = 1.67; 95% confidence interval [CI]: 1.21, 2.30). Among individual items, "space taken up by PD supplies" was commonly rated as a disadvantage and had the strongest association with transition to HD (HR = 1.28; 95% CI 1.07, 1.53). Lower ADS was strongly associated with worse QOL rating and greater depressive symptoms. CONCLUSIONS:Although patients reported a generally favorable perception of PD, patient-reported disadvantages were associated with transition to HD, lower QOL, and depression. Strategies addressing these disadvantages, in particular reducing solution storage space, may improve patient outcomes and the experience of PD.

Project description:BackgroundDifferent approaches have been used in case-control studies to estimate maternal exposure to medications and the risk of birth defects. However, the performance of these approaches and how they affect the odds ratio (OR) estimates have not been evaluated using birth-defect surveillance programmes. The aim of this study was to evaluate the scope and limitations of three case-control approaches to assess the teratogenic risk of birth defects in mothers exposed to antiepileptic medications, insulin, or acetaminophen.Methodology/principal findingsWe studied 110,814 non-malformed newborns and 58,514 live newborns with birth defects registered by the Latin American Collaborative Study of Congenital Anomalies (ECLAMC) between 1967 and 2008. Four controls were randomly selected for each case in the same hospital and period, and three different control groups were used: non-malformed newborns (HEALTHY), malformed newborns (SICK), and a subgroup of SICK, only-exposed cases (OECA). Associations were evaluated using OR and Pearson's chi-square (P<0.01). There were no concordance correlations between the HEALTHY and OECA designs, and the average OR differences ranged from 3.0 to 11.5 for the three evaluated medicines. The overestimations observed for HEALTHY design were increased as higher OR values were given, with a high and statistically significant correlation between the difference and the mean. On the contrary, the concordance correlations obtained between the SICK and OECA designs were quite good, with no significant differences in the average risks.ConclusionsThe HEALTHY design estimates the true population OR, but shows a high rate of false-positive results presumably caused by differential misclassification bias. This bias decreases with the increase of the proportion of exposed controls. SICK and OECA odds ratios cannot be considered a direct estimate of the true population OR except under certain conditions. However, the SICK and OECA designs could provide practical information to generate hypotheses about potential teratogens.

Dataset Information

How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study.

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How do patients and general practitioners in Denmark perceive the communicative advantages and disadvantages of access via email consultations? A media-theoretical qualitative study.

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