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CATCH-IT: Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation,[object Object],NicolNijland, Julia E.W.C. van Gemert-Pijnen, Henk Boer, Michaël F. Steehouder, Erwin R. Seydel, International Journal of Medical Informatics - October 2009 (Vol. 78, Issue 10, Pages 688-703, DOI: 10.1016/j.ijmedinf.2009.06.002),[object Object],By: Marjan Moeinedin,[object Object],October 26, 2009,[object Object]
Article information,[object Object],Research elements,[object Object],Background ,[object Object],Objective,[object Object],Method,[object Object],Analysis,[object Object],Results,[object Object],Discussion,[object Object],Conclusion,[object Object],Questions to the authors,[object Object],Class discussion,[object Object],Table of Contents,[object Object],2,[object Object]
Article Information,[object Object]
This study was supported by The Federation of Patients and Consumer Organizations in the Netherlands.,[object Object],Article History: ,[object Object],Received 12 February 2009,[object Object],Received in revised form 16 June 2009,[object Object],Accepted 20 June 2009,[object Object],Article history:,[object Object],4,[object Object]
NicolNijland(PHD student, 2006-010),[object Object],Department of Psychology and Communication of Health and Risk, Faculty of Behavioral Sciences, University of Twente, Enschede, The Netherlands.,[object Object],First Author,[object Object],5,[object Object]
Research Elements ,[object Object]
In spite of  the substantial increase in the use of Internet as a source for health information, the use of e-consultation remains relatively low. (Pew Internet website),[object Object],Potential benefits of e-consultation:,[object Object],Increased access to care. ,[object Object],Patients can ask questions from any place and at any time ,[object Object], Increased self-management support for individuals with significant medical problems.,[object Object],e-consultation use can empower patients’ self-control skills and strengthen their autonomy ,[object Object], Reduced costs while maintaining the same or achieving better quality of care. ,[object Object],e-consultation can respond to an increasing demand for care in the aging society ,[object Object],Background ,[object Object],7,[object Object]
The motivations for using two types of e-consultation provided in Netherlands was investigated,[object Object],Direct e-consultation: ,[object Object],consulting a GP through secured e-mail.,[object Object],Indirect e-consultation: ,[object Object],consulting a GP through secured email with intervention of a Web-based triage system.,[object Object],Background ,[object Object],8,[object Object]
   To identify factors that can increase the use of e-consultation among non-users: patients with access to Internet, but with no prior e-consultation experience.,[object Object],Objective,[object Object],9,[object Object]
On-line Survey instrument,[object Object],[object Object]
The survey was pre-tested by patients recruited through the Dutch Federation of Patients and Consumer Organizations.
The survey covered 7main topics and contained	a total of 45 items.,[object Object],Method ,[object Object],10,[object Object]
Topic 1: asked whether patients had experience with e-consultation (Yes/No). ,[object Object],Topics 2–6 consisted of multiple statements, which could be answered on a 5-point scale ranging from strongly disagree (1) to strongly agree (5). ,[object Object],Topic 2 (seven statements) examined possible barriers to using e-consultation.,[object Object],Topic 3 (ten statements) assessed patients’ demands regarding e-consultation. ,[object Object],Survey Items,[object Object],11,[object Object]
Topic 4 (seven statements) identified motivations for using e-consultation. ,[object Object],Topics 5-6 (seven statements and eight statements) assessed the motivation  for using two types of e-consultation: direct e-consultation and indirect e-consultation. ,[object Object],Topic 7 questions  were related to ’ socio-demographic and health-related characteristics, such as gender, age, education level, chronic use of medication, and frequency of seeing a GP.,[object Object],Survey Items (cont’d),[object Object],12,[object Object]
[object Object]
18 years of age and above.
Patients with various chronic conditions and basic Internet skills who have visited health-related websites.
Participants were recruited through banners on frequently visited websites of 26 well-trusted patient organizations.
All organizations were members of the Dutch Federation of Patients and Consumer Organizations.
By clicking on a banner patients were automatically linked to the online survey, which was available for a period of 11 weeks.Participants Recruitment,[object Object],13,[object Object]
SPSS version 13.0,[object Object],Descriptive statistics, mean, sum of scores were computed for all constructs .,[object Object],Internal consistency of all constructs was satisfactory ,[object Object],Cronbach’s = 0.64 to 0.84. ,[object Object],F-tests (one-way ANOVA) were used to identify significant differences between independent variables of interest. ,[object Object],Linear regression models were used to predict the dependent variable ‘motivation for using e-consultation’ (mean score of questions 4–6, Cronbach’s ˛ = .86).,[object Object],Data analysis,[object Object],14,[object Object]
 Independent predictors included: ,[object Object],barriers towards e-consultation,[object Object],demands regarding e-consultation,[object Object],socio-demographic and health-related characteristics,[object Object],age, ,[object Object],education level ,[object Object],medication use,[object Object],frequency of seeing a GP ,[object Object],Two-tailed significance was considered at the p < .05 level.,[object Object],Data analysis (cont’d),[object Object],15,[object Object]
Study participants,[object Object],Of the total sample (n = 1706), 1066 were eligible ,[object Object],163 patients (9.6%) had experience with e-consultation. ,[object Object],Of the remaining 1543 patients (90.4%) who had no prior e-consultation experience, only 1066 patients were eligible for the analysis. ,[object Object],Patients who had filled out only 1 question were excluded. ,[object Object],n varied since patients could skip questions.,[object Object],Results,[object Object],16,[object Object]
Results (cont’d),[object Object],Table 1: Characteristics of participants,[object Object],Highlights of Table 1: ,[object Object],(62.4%) Female,[object Object],(70.2%) frequent GPs visitors ,[object Object],The mean age was 49 years old (SD = 13.5) ,[object Object],50% of the patients were highly educated (50.9%).,[object Object],Highlights of table 1,[object Object],17,[object Object]
The most prominent reasons for not using e-consultation:,[object Object], 65%  were not aware of the existence of e-consultation services,[object Object],56%  preferred to see a doctor,[object Object],53% had limited access to e-consultation services, because their GP did not provide e-consultation ,[object Object],Computer or Internet skills were not expected to be a problem ,[object Object],66.1% did not know whether the use of e-consultation is refunded by their insurer,[object Object],Results: Barriers towards e-consultation,[object Object],18,[object Object]
Barriers towards e-consultation (%),[object Object],19,[object Object]
The top priority regarding demands for e-consultation:,[object Object],98%  agreed on getting a quick response ,[object Object],63.9 %  agreed that it was important for their GP to answer their question,[object Object],all other demands were almost equally important to the patients,[object Object],Results: Demands regarding e-consultation,[object Object],20,[object Object]
 Demands regarding e-consultation (%) ,[object Object],21,[object Object]
Patients were fairly willing to use e-consultation:,[object Object],92%   to have the ability to contact a GP regardless of time ,[object Object],81.3%  to have the ability to contact a GP regardless of place,[object Object],86.3%  to have the possibility to formulate questions undisturbed,[object Object],Results: Motivations for using e-consultation,[object Object],22,[object Object]
Motivations for using e-consultation in general (%),[object Object],23,[object Object]
[object Object]
Direct - consulting a GP through secured email
In-direct – consulting a GP through secured e-mail with intervention of a triage mechanism for advice on whether it is necessary to see a doctor and for self-care adviceResults: Motivations for using e-consultation,[object Object],24,[object Object]
motivations for using direct e-consultation:,[object Object],88.2% the possibility to ask additional questions after a visit to the doctor,[object Object],78.4% the possibility to ask questions about medication use,[object Object],55.5% Getting advice on how to handle a health problem,[object Object], 45.9% asking questions about the costs and payment of treatments ,[object Object],The last two points were less of a motivation to use e-consultation. ,[object Object],Results: Motivations for using e-consultation,[object Object],25,[object Object]
Motivations for using direct e-consultation (%),[object Object],26,[object Object]
motivations for using indirect e-consultation:,[object Object],Agreement on the statements was fairly high overall ,[object Object],87.8 %  to decide if a visit to the GP was necessary,[object Object],83.7%   to get self-care advice,[object Object],80.3%  to reduce uncertainty,[object Object],47%  to ask questions anonymously ,[object Object],41%  felt no need for anonymous inquiries,[object Object],Results: Motivations for using e-consultation,[object Object],27,[object Object]
Motivations for using indirect e-consultation (%),[object Object],28,[object Object]
[object Object]
high correlation between demands for using e-consultation and patients’ characteristics
The motivation for using e-consultation increased
as more demands were satisfied such as getting a timely response
Of all patient characteristics
education level and age were the strongest predictors of the motivations for using e-consultation
The less-educated and elderly patients seemed more strongly motivated to use the service than the more highly educated and younger patientsResults: Main drivers for e-consultation,[object Object],29,[object Object]
Bivariate correlations and regression analyses: predictors associated with ‘motivations for using e-consultation,[object Object],30,[object Object]
Distinct patient groups were compared regarding,[object Object], age,[object Object],education level,[object Object],chronic use of medication,[object Object],frequency of GP visits,[object Object],Focus was on the patient groups that,[object Object], have a greater change of being left behind,[object Object],could benefit from e-consultation because of their increasing demand for care,[object Object],Results: Comparison of patient groups on barriers,demands and motivations regarding e-consultation,[object Object],31,[object Object]
Distinguished patient groups (n = 1066),[object Object],32,[object Object]
[object Object]
lower Internet skills
greater concerns about the costs of using e-consultation
Less-educated patients

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Increasing the use of e-consultation in primary care

Hinweis der Redaktion

  1. http://eurpub.oxfordjournals.org/cgi/reprint/17/6/545
  2. http://www.gw.utwente.nl/pcgr/en/emp/nijland/The PhD-project of Nicol focuses on the implementation and performance of interactive Web-based programs for supporting self-care management of patients. Particular emphasis is laid on patients with chronic conditions.
  3. Pew Internet Website: http://www.pewinternet.org/Presentations/2008/Degrees-of-Access-(May-2008-data).aspx
  4. The statements were based on previous studies about barriers and motivations regarding the use of e-consultation in primary care among early adopters [8–11,17–24] and referred to aspects with significant impact on e-consultation use, such as convenience, self-control, self-management of care and the use of different formats for self-control.
  5. Examples of member org. : National Federation of Cancer Patients, The COPD Patient Association,the Dutch Diabetes Association, the Cardiovascular Diseases Association, the Dutch Muscular Diseases Federation,Association of Patients in Mental Health Care, the Skin Diseases Federation, the Dutch Association for Patients with Hearing Problems.
  6. Probability that a difference or significant happened by chanceIs the probability that the null hypothesis is through (range 0-1) midpoint 0.05 about this point there is no significance.
  7. Dependent variable is not continuous data and no normal distribution exists. The data scored from 1-5