Increased virtual access to physicians prompts patients to use more clinical services, study finds


In a relatively unexpected turn of events, researchers studying the outlier effects of virtual access to physicians discovered that the more extensive the online allowance, the more likely a patient was to use in-person and telephone clinical services.

"The presumption is if patients could look up health information such as their test results, request prescription refills, schedule appointments, and send secure e-mail to clinicians, then their use of clinical in-person and telephone calls may decrease,” the study authors wrote of their shattered expectations.

Kaiser Permanente Colorado assembled the study’s subject pool, drawing participants from its roughly 500,000 member costumer base. From March 2005 to June 2010, patients 18 years or older with access to Kaiser’s EHR and MyHealthManager systems were observed for their healthcare use habits — their medical histories, online proficiency and their likelihood to employ in-person services. [Refer to Figure 1 for more subject pool specifics].

Figure 1:

According to American Academy of Family Physicians (AAFP) analysis of the report: “When comparing the use of clinical services between portal users and nonusers within a specific time period, researchers saw a significant increase in per-member rates of office visits (0.7 per member per year) and telephone encounters (0.3 per member per year). Researchers also noted a significant increase in per-1000-member rates (per year) of after-hours clinic visits (18.7), emergency department encounters (11.2) and hospitalizations (19.9).”

What’s more, patients with asthma and diabetes who utilized virtual patient portals raised their office visitation, hospitalization rates and after-hours contact; patients diagnosed with congestive heart failure were also found to engage in telephone interaction more often despite portal proficiency. 

While it may seem natural to conclude from the findings that online access is ineffective in the realm of healthcare correspondence, the authors were hasty to hail the results as far more complex than such an explanation allows.

“The relationship between online access and utilization is more complex than the simple substitution of online for in-person care suggested by earlier studies," the report reads.

“Perhaps patients with online access may be more engaged in their healthcare and therefore use more clinical services,” corresponding author Ted Palen, PhD, MD, explained to AAFP News Now.

"The takeaway for physicians is not to be afraid of patient portals. Patients like them,” Palen added. “Both patients and clinicians need to learn to use them to improve healthcare delivery. Physicians may need to anticipate an initial increased need for clinical services, but perhaps this will improve the health for patients in the long run.”

View the report in its entirety — published in the latest issue of The Journal of the American Medical Association — here.

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