Patient Healthcare Communication Preferences for Primary Care: Do they differ for regular computer users? Sherri L. LaVela 1,2 , Gordon Schectman 3,4 , Jeffrey Gering 5,6 , Sara M. Locatelli 1 , Lorrie Roth 1 , Frances M. Weaver 1,7 1 Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL Department of Veterans Affairs (DVA) 2 Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL 3 Primary Care, Office of Patient Care Services, Veterans Affairs Central Office, Washington DC 4 Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 5 Chillicothe Veterans Affairs Medical Center, OH 6 Ohio University, Chillicothe, OH 7 Program in Health Services Research, Stritch School of Medicine, Loyola University, Maywood, IL 18/OCTOBER 2011
Patient Communication Preferences ICCH 2011
Dec 02, 2014
Patient Healthcare Communication Preferences for Primary Care: Do They Differ for Regular Computer Users?, Authors: Sherri L. LaVela, Gordon Schectman, Jeffrey Gering, Sara M. Locatelli, Lorrie Roth, & Frances M. Weaver
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Patient Healthcare Communication Preferences for Primary Care: Do they differ for regular computer users?
Sherri L. LaVela1,2, Gordon Schectman3,4, Jeffrey Gering5,6, Sara M. Locatelli1, Lorrie Roth1, Frances M. Weaver1,7
1Center for Management of Complex Chronic Care, Edward Hines Jr. VA Hospital, Hines, IL Department of Veterans Affairs (DVA)2Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL3Primary Care, Office of Patient Care Services, Veterans Affairs Central Office, Washington DC4Department of Medicine, Medical College of Wisconsin, Milwaukee, WI5Chillicothe Veterans Affairs Medical Center, OH6Ohio University, Chillicothe, OH7Program in Health Services Research, Stritch School of Medicine, Loyola University, Maywood, IL
18/OCTOBER 2011
VETERANS HEALTH ADMINISTRATION
Disclaimer
• The opinions expressed in this presentation are my own and do not necessarily represent the views of the United States Department of Veterans Affairs or the United States Government.
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VETERANS HEALTH ADMINISTRATION
Background
• Patients have many communication options– Office visits– Telephone– Electronic communications
• Patient preferences important for planning and satisfaction
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VETERANS HEALTH ADMINISTRATION
Background
• How do patients prefer to communicate with their providers?– Preferences depend on information being
communicated• Online for routine information (Flynn 2009; Katz 2003)• Phone or in-person for serious or time-sensitive concerns
(Katz 2003)
– Preferences also depend on current computer and Internet use• About half of patients Internet and/or email users
(Dickerson 2004; McInnes 2010; Moyer 2002)
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VETERANS HEALTH ADMINISTRATION
Methods
• Objective: Examine communication preferences among patients reporting contact to a VA primary care clinic
• Participants: Cross-sectional structured interviews with Veteran primary care cohort (n=448) from 14 nationally dispersed Veterans Affairs (VA) primary care clinics
• Data Source: Interviews conducted with convenience sample of Veterans who utilized primary care at VA facilities
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VETERANS HEALTH ADMINISTRATION
Methods
• Measures: Questions about sociodemographics and health characteristics, computer use, communication preferences (in-person, telephone, electronic) for healthcare-related reasons, importance of familiarity versus rapid response
• Analysis: univariate and bivariate analyses conducted by computer usage frequency– Low Users: 2-3 times per month or less– Regular Users: Once per week or greater
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VETERANS HEALTH ADMINISTRATION
Results46% low computer users 54% regular computer
users
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Overall (n=443)
Low Computer Users (n=205)
Regular Computer Users (n=238)
p
% Male 89 93 87 0.04
Mean (SD) age in years 61.89 (13.29)
67.02 (10.93) 57.37 (13.55) <0.01
% Poor/Fair Health 44 53 35 <0.01
Mean (SD) travel time in minutes
46.69 (37.33)
51.33 (35.77) 42.89 (37.93) 0.02
% Driven by Self/Caregiver
91 90 91 0.35
% VA Care only 71 74 70 0.42
VETERANS HEALTH ADMINISTRATION
Patient Communication Preferences (%)
8
In-Person
Telephone
Electronic
Scheduling appointments 17 69 14
Refill/Renew Prescriptions 15 67 18
Preventive Care Reminders 20 59 21
Question about medications 32 53 15
Answers to general medical questions 34 51 15
Obtain information on test results 39 42 19
Concerns about new condition or symptoms
73 22 5
Concerns about chronic or ongoing condition
67 25 8
Instructions about treatment 60 32 8
Obtain information about next steps in care
53 36 11
9
In-Person Telephone Electronic
Low Users
Regular Users
Low Users
Regular Users
Low Users
Regular Users
Scheduling appointments 21 13 78 63 1 24
Refill/Renew Prescriptions 19 11 79 56 2 32
Preventive Care Reminders 29 12 70 51 1 37
Question about medications 39 27 60 48 1 26
Answers to general medical questions
41 29 59 44 1 27
Obtain information on test results
48 31 51 35 2 34
Concerns about new condition or symptoms
74 72 25 19 1 9
Concerns about chronic or ongoing condition
72 63 27 22 1 15
Instructions about treatment 62 58 37 28 1 14
Obtain information about next steps in care
56 51 43 29 1 20
10
In-Person Telephone Electronic
Low Users
Regular Users
Low Users
Regular Users
Low Users
Regular Users
Scheduling appointments 21 13 78 63 1 24
Refill/Renew Prescriptions 19 11 79 56 2 32
Preventive Care Reminders 29 12 70 51 1 37
Question about medications 39 27 60 48 1 26
Answers to general medical questions
41 29 59 44 1 27
Obtain information on test results
48 31 51 35 2 34
Concerns about new condition or symptoms
74 72 25 19 1 9
Concerns about chronic or ongoing condition
72 63 27 22 1 15
Instructions about treatment 62 58 37 28 1 14
Obtain information about next steps in care
56 51 43 29 1 20
VETERANS HEALTH ADMINISTRATION
Patient Primary Care Contact Preferences (%)
11
Very Important
Important
Neutral
Unimportant
Not at all Important
Talking to a nurse from your primary care team
69 16 11 2 2
Talking to nurse with whom had prior contact
60 21 14 2 3
Receiving immediate advice
53 26 19 1 1
Talking to any nurse as soon as possible
50 31 17 2 0
VETERANS HEALTH ADMINISTRATION
Conclusions
• Telephone preference: general questions, medication questions, reminders, prescriptions refills, scheduling, test results
• In-person preference: chronic conditions, new symptoms, treatment instructions, and next steps in care
• Regular users more likely to prefer electronic communication methods
• Familiarity with staff member rated as more important than rapid response
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VETERANS HEALTH ADMINISTRATION
Limitations and Future Directions
• Participants may not represent VA patients in general
• Future research – Compare self-reported preferences to actual use– Use qualitative methods to explore preferences
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VETERANS HEALTH ADMINISTRATION
References
• Dickerson S, Reinhart AM, Feeley TH, et al. Patient internet use for health information at three urban primary care clinics. J Am Med Inform Assoc. 2004;11:499-507.
• Flynn D, Gregory P, Makki H, Gabbay M. Expectations and experiences of eHealth in primary care: A qualitative practice-based investigation. Int J Med Inform. 2009;78:588-604.
• Katz SJ, Nissan N, Moyer CA. Crossing the digital divide: Evaluating online communication between patients and their providers. Am J Manag Care. 2004; 10(9): 593-8.
• McInnes DK, Gifford AL, Kazis LE, Wagner TH. Disparities in health-related internet use by US Veterans: Results from a national survey. Inform Prim Care. 2010;18:59-68.
• Moyer CA, Stern DT, Dobias KS, Cox DT, Katz SJ. Bridging the electronic divide: Patient and provider perspectives on e-mail communication in primary care. Am J Manag Care. 2002;8:427-433.
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