Abstract
BackgroundThe growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services.ObjectiveThe objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months.MethodsSecondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ≥40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ≥50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted.ResultsAdults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor’s degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95% CI 1.20-1.44) and cervical (OR 1.11, 95% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC.ConclusionsOur results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association.
Highlights
Email patient-provider communication (PPC) is broadly defined to include computer-based PPC “within a contractual relationship in which the health care provider has taken an active measure of responsibility for the clients” [1]
Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast and cervical cancer screenings than women who did not use email PPC
JMIR Cancer 2021 | vol 7 | iss. 3 | e23790 | p. 1 care providers had 1.55 times greater odds of receiving a colon cancer screening than those who did not use email PPC
Summary
Email patient-provider communication (PPC) is broadly defined to include computer-based PPC “within a contractual relationship in which the health care provider has taken an active measure of responsibility for the clients” [1]. Email PPC includes messages sent through electronic personal health management tools and patient portals, which can enhance traditional face-to-face communication between health care providers and patients. Several studies have found that non-Hispanic White adults are more likely to use email PPC than non-Hispanic Black and Hispanic adults [4], yet the usage of email PCC among Hispanic adults varies by US- and foreign-born subgroups [12]. These differences may be due to structural barriers that exist with broadband internet access, which may be more limited in poor neighborhoods [13]. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services
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