Electronic Health Communications Often Unavailable to Lower-Income Patients

hands using iphone
Lower-income patients want to communicate electronically with their doctors, but the revolution in health care technology often is not accessible to them, due to inadequate health information services within the health care clinics they frequent, according to a survey by UC San Francisco researchers.

Increasing numbers of health care systems are offering online services to patients in order to manage care outside of office visits, and this often includes the ability for patients to communicate electronically with health care providers.

The UCSF research team found that a significant majority of uninsured and underinsured patients currently use email, text messaging, and the Internet in their everyday lives and would like to extend that to their health care, but the “safety net” clinics they use generally do not offer the necessary patient portal or secure messaging to support this communication.

“Electronic health-related communication is becoming the standard of care in well-resourced settings, and should be implemented and supported in resource-poor settings,” said senior author Urmimala Sarkar, MD, MPH, who is an assistant professor of medicine with the UCSF Department of Medicine, Division of General Internal Medicine, and the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center.

The analysis is reported online Monday in the Journal of General Internal Medicine.

Urmimala Sarkar, M.D

Urmimala Sarkar, M.D

The study surveyed 416 patients seen in six San Francisco Department of Public Health community clinics serving primarily uninsured and publicly insured patients. Participants were ethnically and racially diverse, low-income, spoke twenty-four different primary languages and were generally representative of the overall clinic network population. Fifty-four percent said they obtained general information from the Internet.

While 17 percent of patients currently reported using email informally with health providers as a part of their care, the vast majority (78 percent) of respondents expressed interest in electronic communication. In addition, 60 percent of those surveyed were current email users, suggesting that the majority of vulnerable patients served in these clinics already had both some level of computer access and Internet skills.

Although a recent national study suggested that three-fourths of patients were interested in such electronic communication, there has been little research to understand interest among lower income patients, such as those receiving care at public clinics, as these patients are somewhat less likely to have access to computers and/or the Internet.

“Patients were largely in favor of using email technology for health and agreed it would likely improve overall clinical communication and efficiency,” said lead author Adam Schickedanz, MD, a medical resident in the UCSF Department of Pediatrics. “Our work makes it clear that lower income patients from a wide variety of backgrounds want to be part of the health information technology revolution.

“The question is whether they will be afforded the opportunities to take part in the same way as their middle and higher-income peers,” he said.

According to researchers, future research should aim to understand diverse patient preferences for ultimately engaging in electronic communication with providers, including additional tailoring of existing systems to support language- and literacy-appropriate access.

Other study authors are David Huang, MD, of the UCSF Department of Internal Medicine; Andrea Lopez, BS, and C.R. Lyles, PhD, of the Center for Vulnerable Populations at San Francisco General Hospital and the UCSF Department of Internal Medicine; Tom Bodenheimer, MD, MPH, of the UCSF Department of Family and Community Medicine; and Edna Cheung, BA, of UC Berkeley.

Schickedanz was supported by the UCSF Clinical and Translational Science Institute, and Sarkar was funded by the Agency for Health Care Research and Quality. The authors have no conflicts to disclose.