Computer-using patients want Internet services from family physicians

Patients are increasingly using the Internet to obtain medical information. Few practice Web sites provide services beyond information about the clinic and common medical diseases. We surveyed computer-using patients at 4 family medicine clinics in Denver, Colorado, by assessing their desire for Internet services from their providers. Patients were especially interested in getting e-mail reminders about appointments, online booking of appointments in real time, and receiving updates about new advances in treatment. Patients were also interested in virtual visits for simple and chronic medical problems and for following chronic conditions through virtual means. We concluded that computer-using patients desire Internet services to augment their medical care. As growth and communication via the Internet continue, primary care physicians should move more aggressively toward adding services to their practices’ Internet Web sites beyond the simple provision of information.

Patients are increasingly using the Internet to obtain medical information. A recent Harris poll estimated that 98 million Americans have retrieved health-related information online, an increase of 44 million since 1998.¹ Previous studies examined patients’ subjective ratings² of medical information sites and assessed the quality of medical information available through the World Wide Web.³ However, very little research has been published regarding patients’ interest in “e-health” services.^4,5 The health care industry lags far behind other industries in terms of providing useful Internet services for the consumer.

We hypothesized that computer-using patients were interested in using the current and potential future services of Web-based technology to augment their care through clinic-based Web sites. The purpose of this study was to specifically determine the interests and needs of computer-using patients in clinic Web services beyond informational services alone.

Methods

An anonymous survey was given to a convenience sample of patients from 4 Denver Family Medicine clinics, with each surveying anywhere from 40 to 110 patients. The clinical sites used in this survey were socioeconomically diverse and included 1 community-based residency clinic, 1 university-based residency clinic, and 2 health maintenance organization clinics. A total of 600 surveys were distributed. Patient surveys were placed at the front desk, where the personnel were requested to ask patients to complete this volunteer survey. Computer and noncomputer users were asked to take the survey and their computer-using status was noted on the survey. Surveys were completed during the visit and returned to the front desk for collection. The surveys represented visits in these clinics from July 2000 to November 2000. This anonymous survey assessed patient demographics, Internet use, and patients’ interest in Internet services. Preferences for 22 Internet services were assessed on a Likert scale of 1 (definitely would not use) to 10 (definitely would use).

Data were analyzed using SPSS version 10 for Windows (SPSS Inc., Chicago, IL). Only computer users were included in the final calculations because of the very small percentage of noncomputer users (7.4%) who volunteered to take the survey. Frequencies were used to describe the computer-using survey respondents, their use of computers, and their preferences for Web-based services. Tests were used to evaluate significant variations among the survey respondents.

Results

Of 600 surveys, 227 were returned (37.8%). Most respondents were female (66.3%) with a mean age of 44.7 years. The vast majority of those who responded to this survey owned computers at home (90.0%) and/or had them at work (83.7%); 44.5% were college graduates and 52.1% had chronic medical conditions. Data on patients’ current use of the Internet are shown in Table 1.

Patient’s desires for Web-based services are summarized in Table 2. Patients displayed a strong interest in front desk services such as being able to book appointments in real time (mean Likert score, 8.50) over the Internet and getting e-mail reminders about appointments (mean Likert score, 8.61). Back office services ranking high included requesting medication refills online (mean Likert score, 8.47) to requesting a referral (mean Likert score, 8.26). The ability to send a message to “your doctor” also ranked high (mean Likert score, 8.40). There was relatively little interest in taking a virtual tour of the clinic (mean Likert score, 6.26) or having a page of links to health insurance company Web sites (mean Likert score, 6.73).

Patients displayed moderate interest in virtual visits (a patient-to-physician encounter conducted using the Internet alone), with 66.0% showing interest in a virtual visit for a simple medical problem. A slightly lower percentage (57.7%) was interested in a virtual visit for a chronic medical problem. Approximately a third of patients (32.6%) was more interested in a real-time virtual visit that used a personal computer (PC) videoconference rather than a real-time e-mail conversation (ie, “chat room” or one-on-one “chat”). Not surprisingly, a larger percentage of patients was more willing to make a virtual visit if it offered a lower co-payment (62%). Only 46.7% of patients indicated they would be interested in a virtual visit if it required the usual co-payment.