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Meta-Analysis
. 2012 Nov 14;11(11):CD007978.
doi: 10.1002/14651858.CD007978.pub2.

Email for clinical communication between patients/caregivers and healthcare professionals

Helen Atherton  1 , Prescilla Sawmynaden, Aziz Sheikh, Azeem Majeed, Josip Car
Affiliations
Meta-Analysis

Email for clinical communication between patients/caregivers and healthcare professionals

Helen Atherton et al. Cochrane Database Syst Rev. .

Abstract

Background: Email is a popular and commonly-used method of communication, but its use in health care is not routine. Where email communication has been demonstrated in health care this has included its use for communication between patients/caregivers and healthcare professionals for clinical purposes, but the effects of using email in this way is not known.This review addresses the use of email for two-way clinical communication between patients/caregivers and healthcare professionals.

Objectives: To assess the effects of healthcare professionals and patients using email to communicate with each other, on patient outcomes, health service performance, service efficiency and acceptability.

Search methods: We searched: the Cochrane Consumers and Communication Review Group Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1 2010), MEDLINE (OvidSP) (1950 to January 2010), EMBASE (OvidSP) (1980 to January 2010), PsycINFO (OvidSP) (1967 to January 2010), CINAHL (EbscoHOST) (1982 to February 2010) and ERIC (CSA) (1965 to January 2010). We searched grey literature: theses/dissertation repositories, trials registers and Google Scholar (searched July 2010). We used additional search methods: examining reference lists, contacting authors.

Selection criteria: Randomised controlled trials, quasi-randomised trials, controlled before and after studies and interrupted time series studies examining interventions using email to allow patients to communicate clinical concerns to a healthcare professional and receive a reply, and taking the form of 1) unsecured email 2) secure email or 3) web messaging. All healthcare professionals, patients and caregivers in all settings were considered.

Data collection and analysis: Two authors independently assessed the risk of bias of included studies and extracted data. We contacted study authors for additional information. We assessed risk of bias according to the Cochrane Handbook for Systematic Reviews of Interventions. For continuous measures, we report effect sizes as mean differences (MD). For dichotomous outcome measures, we report effect sizes as odds ratios and rate ratios. Where it was not possible to calculate an effect estimate we report mean values for both intervention and control groups and the total number of participants in each group. Where data are available only as median values it is presented as such. It was not possible to carry out any meta-analysis of the data.

Main results: We included nine trials enrolling 1733 patients; all trials were judged to be at risk of bias. Seven were randomised controlled trials; two were cluster-randomised controlled designs. Eight examined email as compared to standard methods of communication. One compared email with telephone for the delivery of counselling. When email was compared to standard methods, for the majority of patient/caregiver outcomes it was not possible to adequately assess whether email had any effect. For health service use outcomes it was not possible to adequately assess whether email has any effect on resource use, but some results indicated that an email intervention leads to an increased number of emails and telephone calls being received by healthcare professionals. Three studies reported some type of adverse event but it was not clear if the adverse event had any impact on the health of the patient or the quality of health care. When email counselling was compared to telephone counselling only patient outcomes were measured, and for the majority of measures there was no difference between groups. Where there were differences these showed that telephone counselling leads to greater change in lifestyle modification factors than email counselling. There was one outcome relating to harm, which showed no difference between the email and the telephone counselling groups. There were no primary outcomes relating to healthcare professionals for either comparison.

Authors' conclusions: The evidence base was found to be limited with variable results and missing data, and therefore it was not possible to adequately assess the effect of email for clinical communication between patients/caregivers and healthcare professionals. Recommendations for clinical practice could not be made. Future research should ideally address the issue of missing data and methodological concerns by adhering to published reporting standards. The rapidly changing nature of technology should be taken into account when designing and conducting future studies and barriers to trial development and implementation should also be tackled. Potential outcomes of interest for future research include cost-effectiveness and health service resource use.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
Flow diagram illustrating search results.
2
2
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
4.1
4.1. Analysis
Comparison 4 Email compared to standard methods of communication: Primary outcome, patient behaviours/actions, Outcome 1 Used the Internet to find information about your disease.
4.2
4.2. Analysis
Comparison 4 Email compared to standard methods of communication: Primary outcome, patient behaviours/actions, Outcome 2 Used Internet to find information about where to seek treatment.
5.1
5.1. Analysis
Comparison 5 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; patient participants, Outcome 1 Mean number of contacts to GP and front office during study period: change from baseline.
5.2
5.2. Analysis
Comparison 5 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; patient participants, Outcome 2 Mean number of office visits per patient per year: change from baseline.
5.3
5.3. Analysis
Comparison 5 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; patient participants, Outcome 3 Mean number of phone consultations per patient per year: change from baseline.
5.4
5.4. Analysis
Comparison 5 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; patient participants, Outcome 4 Visits to complementary therapist: mean reduction.
6.1
6.1. Analysis
Comparison 6 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; physicians participants, Outcome 1 Difference in trend in email rate over intervention period.
6.3
6.3. Analysis
Comparison 6 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; physicians participants, Outcome 3 Difference in trend in telephone call rate over intervention period.
6.7
6.7. Analysis
Comparison 6 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; physicians participants, Outcome 7 Difference in trend in no‐show rate over intervention period.
6.8
6.8. Analysis
Comparison 6 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; physicians participants, Outcome 8 Weekly emails received by residents.
6.9
6.9. Analysis
Comparison 6 Email compared to standard methods of communication: Primary outcome, health service outcome, resource use; physicians participants, Outcome 9 Weekly emails received by staff physicians.
7.1
7.1. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 1 Body weight ‐ percentage change from baseline.
7.2
7.2. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 2 Mean absolute weight loss at 6 months (kg).
7.3
7.3. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 3 Waist circumference ‐ mean absolute change from baseline (inches).
7.4
7.4. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 4 Systolic blood pressure ‐ mean absolute change from baseline (mmHg).
7.5
7.5. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 5 Diastolic blood pressure ‐ mean absolute from baseline (mmHg).
7.6
7.6. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 6 Pulse rate (bpm).
7.7
7.7. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 7 Total cholesterol ‐ percentage change from baseline.
7.8
7.8. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 8 Triglycerides ‐ percentage change from baseline.
7.9
7.9. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 9 HDL‐C percentage change from baseline.
7.10
7.10. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 10 LDL‐C ‐ percentage change from baseline.
7.11
7.11. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 11 Fasting glucose ‐ percentage change from baseline.
7.12
7.12. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 12 Insulin ‐ percentage change from baseline.
7.13
7.13. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 13 Weight loss of at least 5%.
7.14
7.14. Analysis
Comparison 7 Email compared to telephone for delivery of counselling: Primary outcome, patient health status and wellbeing, Outcome 14 Weight loss of at least 10%.
8.1
8.1. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 1 IWQOL‐Lite score ‐ mean absolute change from baseline.
8.2
8.2. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 2 WRSM total bothersome score ‐ mean absolute change from baseline.
8.3
8.3. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 3 Adherence to dietician contact.
8.4
8.4. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 4 Web utilisation.
8.5
8.5. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 5 Mean number of logins to the website.
8.6
8.6. Analysis
Comparison 8 Email compared to telephone for delivery of counselling: Primary outcome, patient behaviours/actions, Outcome 6 Mean number of days participants logged into website to enter information.
9.1
9.1. Analysis
Comparison 9 Email compared to telephone for delivery of counselling: primary outcomes: harms, Outcome 1 Discontinued participation due to adverse effects.
10.1
10.1. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 1 Email benefits scale (Physicians' perceived benefits of email use with patients).
10.2
10.2. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 2 Email bother scale (Physician perceptions of levels of 'bother' with different types of patient email).
10.3
10.3. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 3 I like using email to communicate with my patients.
10.4
10.4. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 4 Perception that email is a good way to answer patients' non‐urgent medical questions.
10.5
10.5. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 5 Perception that email is helpful for handling patients' administrative concerns.
10.6
10.6. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 6 How much of a problem are emails from patients who haven't seen you in a long time?.
10.8
10.8. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 8 Physicians web benefits scale: would encourage my patients to use web; agree/strongly agree.
10.9
10.9. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 9 Physicians web benefits scale ‐would be a good way for my patients to contact me; agree/strongly agree.
10.10
10.10. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 10 Physicians web benefits scale ‐ would be a good way to follow up after an appointment; agree/strongly agree.
10.11
10.11. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 11 Physicians web benefits scale ‐ would like to use web to communicate with patients; agree/strongly agree.
10.12
10.12. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 12 General Communication Scale.
10.13
10.13. Analysis
Comparison 10 Email compared to standard methods of communication: Secondary outcome, health professional perceptions, Outcome 13 Physician satisfaction with patient communication outside of clinical visits.
11.1
11.1. Analysis
Comparison 11 Email compared to standard methods of communication: Secondary outcomes, patient outcome, effect on patient‐professional communication, Outcome 1 Communicating nonurgent messages to doctor and/or nurse rated as excellent/very good.
11.2
11.2. Analysis
Comparison 11 Email compared to standard methods of communication: Secondary outcomes, patient outcome, effect on patient‐professional communication, Outcome 2 Communicating nonurgent messages to doctor and/or nurse rated as poor.
14.1
14.1. Analysis
Comparison 14 Email compared to standard methods of communication: Secondary outcome, health service outcomes, use of medical services, Outcome 1 Number of patients who initiated additional contact with the surgeon.
14.2
14.2. Analysis
Comparison 14 Email compared to standard methods of communication: Secondary outcome, health service outcomes, use of medical services, Outcome 2 Telephone messages per patient (for those consenting to allow a view of their medical record only).
14.3
14.3. Analysis
Comparison 14 Email compared to standard methods of communication: Secondary outcome, health service outcomes, use of medical services, Outcome 3 Total messages (telephone plus portal) per patient (for those patients consenting to allow a view of their medical record).
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Update of

  • doi: 10.1002/14651858.CD007978

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References to other published versions of this review

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