Article Text
Abstract
Objectives It is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.
Setting For this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.
Participants 200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).
Primary outcome measures The number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.
Results 32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.
Conclusion Even though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.
- primary care
- patient
- email-consultation
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Statistics from Altmetric.com
Footnotes
Contributors All authors conceived the study. RAV supervised the data collection. MWJH performed the analyses. All authors had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors contributed to the interpretation of the data. MWJH wrote the draft of the manuscript with the help of ICSS, RAV, RDF, OCPvS and LPdW. All authors read and approved the final manuscript.
Funding This study is part of a PhD project, which is partly funded by a grant from the Netherlands Organization for Health Research and Development (ZonMw), grant 10-10400-98-009, and partly funded by Maastricht University/School for Public Health and Primary Care. MWJH, ICSS, RDF, OCPvS and LPdW had financial support from ZonMw for the submitted work. MWJH has the right to grant on behalf of all authors and does grant on behalf of all authors, a worldwide licence to the Publishers and its licencees in perpetuity, in all forms, formats and media (whether known now or created in the future), to (1) publish, reproduce, distribute, display and store the Contribution, (2) translate the Contribution into other languages, create adaptations, reprints, include within collections and create summaries, extracts and/or abstracts of the Contribution, (3) create any other derivative work(s) based on the Contribution, (4) to exploit all subsidiary rights in the Contribution, (5) the inclusion of electronic links from the Contribution to third party material wherever it may be located and (6) licence any third party to do any or all of the above.
Competing interests None declared.
Patient consent Not required.
Ethics approval The Dutch law allows the use of electronic health records for research purposes under certain conditions. According to this legislation, neither obtaining informed consent from patients nor approval by a medical ethics committee is obligatory for this type of study containing no directly identifiable data (Dutch Civil Law, Article 7:458). This study has been approved according to the governance code of NIVEL Primary Care Database, under number NZR-00315.062.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical appendix, statistical code and data set available on reasonable request by the corresponding author (MWJH).