Patient-provider secure messaging: Who isn't emailing their doctor and why?

Background: Secure-messaging offers patients and providers an additional channel for communication and care delivery, and may be required for “meaningful use”. There is, however, limited information on factors that affect patients' decisions to use this tool, barriers, and potential disparities in use. Objective/purpose: We examined patient preferences for and barriers to emailing their physician and their impact on secure-messaging use. Methods: We collected telephone, mailed, or on-line surveys from a stratified random sample of adult members of an integrated health delivery system (IDS) who were in the health-plan chronic disease registries; all could use a patient-provider secure-message (email) tool on the IDS website. Participants reported their preferences and attitudes toward emailing providers. We used multivariate logistic regression to assess the association between patient characteristics (including age, race, health status, income, education) and attitudes about emailing providers, with use of secure-messaging (analyses weighted for sampling proportions). Results: Overall (N=1041, 87% response rate), 56% had sent a provider a secure-message in the previous year; 41% were non-white, 69% were >age 55, 27% had income <$0,000, 28% rarely/never accessed the Internet. Overall, 63% preferred phone or in-person care vs. emailing their doctor, 20% reported that secure-messaging was complicated to use, and 21% had concerns about secure-message privacy, in multivariate analyses each factor was associated with lower likelihood of using secure-messaging (p<0.001); 39% said it was easier to ask sensitive questions by email and were more likely to secure-message their provider (p<0.001). In multivariate models, patients with higher age, lower education, and rare/no internet access were less likely to email their provider (p<0.05). Discussion/conclusions. Patient characteristics and attitudes were associated with using secure-messaging. As adoption of secure-messaging increases, it is important to understand which patients are not emailing providers (including vulnerable populations), the rationale for these choices, and its effects on access to care.