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Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth
  1. Dee Mangin1,
  2. Jenna Parascandalo1,
  3. Olga Khudoyarova1,
  4. Gina Agarwal1,
  5. Verdah Bismah2,
  6. Sherrie Orr3
  1. 1 Family Medicine, McMaster University, Hamilton, Ontario, Canada
  2. 2 Queens University, Kingston, Ontario, Canada
  3. 3 Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
  1. Correspondence to Dr Dee Mangin; mangind{at}


Objective There is increasing awareness of the burden of medical care experienced by those with multimorbidity. There is also increasing interest and activity in engaging patients with chronic disease in technology-based health-related activities (‘eHealth’) in family practice. Little is known about patients’ access to, and interest in eHealth, in particular those with a higher burden of care associated with multimorbidity. We examined access and attitudes towards eHealth among patients attending family medicine clinics with a focus on older adults and those with polypharmacy as a marker for multimorbidity.

Design Cross-sectional survey of consecutive adult patients attending consultations with family physicians in the McMaster University Sentinel and Information Collaboration practice-based research network. We used univariate and multivariate analyses for quantitative data, and thematic analysis for free text responses.

Setting Primary care clinics.

Participants 693 patients participated (response rate 70%). Inclusion criteria: Attending primary care clinic. Exclusions: Too ill to complete survey, cannot speak English.

Results The majority of participants reported access to the internet at home, although this decreased with age. Participants 70 years and older were less comfortable using the internet compared with participants under 70. Univariate analyses showed age, multimorbidity, home internet access, comfort using the internet, privacy concerns and self-rated health all predicted significantly less interest in eHealth. In the multivariate analysis, home internet access and multimorbidity were significant predictors of disinterest in eHealth. Privacy and loss of relational connection were themes in the qualitative analysis.

Conclusion There is a significant negative association between multimorbidity and interest in eHealth. This is independent of age, computer use and comfort with using the internet. These findings have important implications, particularly the potential to further increase health inequity.

  • ehealth
  • multimorbidity
  • primary care

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  • Patient consent for publication Not required.

  • Contributors DM conceived the research study and was responsible for overall design. OK, VB and SO designed and piloted the survey with supervision from DM and JP. OK collected the data. JP inputted the data and carried out the data analysis with DM. DM, JP, GA, SO and VB reviewed the manuscript and made final edits.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained from the Hamilton Integrated Research Ethics Board. Project #14-501.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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