Download pdf - E-health and relationship patient - doctor - EFPC 2014

1171- De Rosis ID:EFPC20141171

Does e-health damage the relationship

patient-general practitioner?

Sabina De Rosis Phd in Management | [email protected]

Sara Barsanti Research Fellow | [email protected]


A wide debate in the scientific community

• There are ambiguous evidences about how use of e-health can impact on the relationship empowered-patient/practitioner.

• There is a wide debate in the scientific and professional community about the role of e-health in the evolution of patient-practitioner relationship.


A wide debate in the scientific community

Less “information asymmetry”. More

balance in who knows what.

Other channels of communication,

together with face-to-face.

More productive consultations.

Empowerment and improved capabilities

of patients’ self-healthcare (chronic

deseases).

Collaborative approach to the

decision process.

More efficiency in the use of time by GPs.

Increase of distances between patients and physicians.

The physician is the only and unique sourch and gatekeeper

of informations.

High risks because:

• Information online is not accurate, or not comprehensible, or not correct…,

• Privacy,

• Less equity of access to care and of empowerment (digital divide, capabilities to use the internet, …).


Which is the PROFILE of the e-health user?

Which are the determinant factors of use of e-health?

Illustration by Thomas James


Which are the PURPOSES OF E-HEALTH USE and relative

determinants? satisfaction and experiences of Primary Care

Illustration by Thomas James


Banksy “Peace and Love Doctor ”

Which are the OUTCOMES of e-health ( relationship between

user-patient and general practitioner) and their determinants?


Data

Database of results of “INDAGINE POPOLAZIONE TOSCANA 2012”, a survey about the satisfaction of inhabitants of Tuscany Region for primary care, local services, information and communication about health services.

The sample is casual and stratified for areas (zona-distretto) with a confidence interval of 95%.

The survey was tested and then administered by CATI (Computer Assisted Telephone Interviews) between November 2012 and February 2013.

The number of respondents is about 7,800 persons.


Methodology

After a co-linearity analysis, descriptive statistics and logistic regression model, using odds ratio for interpretation of results.

Socio-demographic Age Gender Education

Health needs (perceived) Chronic diseases Health status

Enabling resources Internet access at home

Satisfaction for

Time spent with their GP

Explanations offered by their GP

Involvement by GP in the decisions

Suggestions of GP about life style

Overall, for the GP

Knowledge of local care services

Overall, for the local health care

Experience

Number of GP visit per year

Number of times they return to health care offices for the same

purpose


The most likely profile of the Internet-

user in Tuscany Region:

o Young (44% between 18-45 yrs ;

p<.001) or an adult (47.4%

between 46-65 yrs ; p<.001)

o Medium-high level of education

(77.4%; p<.001)

o With a positive perception of

their health status (95%; p=.003)

o Do not suffer of chronic

diseases (67%; p=0.0002)

Of the sub-sample of 2,036 individuals 34% says they use e-health

Results | The e-health user

Illustration: Tracy Walker


Results | The purposes of use

Illustration by Emmanuel Polanco

•Deep info received during a visit

•Look for a service or a doctor

• Self-diagnosis

•Look for a better life style

•Deep info received during a visit 66,4%

•Look for a service or a doctor 46,4%

• Self-diagnosis 25,4%

•Look for a better life style 10,7%


Results | The purposes of use

Factor/characteristic Look for a service or a doctor Deep info received during a visit Look for a better life style Self-diagnosis Satisfaction for GP Explanations not satisfied 1 1 1 1

quite satisfied 0.838 0.335 2.093 0.7050 0.861 0.370 2.004 0.0671 0.241 0.060 0.963 0.1440 1.622 0.440 5.976 0.4674

full satisfied 0.930 0.365 2.370 0.8794 0.709 0.301 1.673 0.1149 0.385 0.092 1.608 0.1906 1.278 0.335 4.878 0.7194 Participation not satisfied 1 1 1 1

quite satisfied 0.536 0.270 1.063 0.0743 0.983 0.524 1.843 0.9569 0.675 0.201 2.267 0.5254 0.902 0.360 2.262 0.8261 full satisfied 0.527 0.270 1.028 0.0603 0.965 0.520 1.791 0.9092 0.532 0.159 1.782 0.3063 0.875 0.352 2.173 0.7734

Suggestions about life style

not satisfied 1 1 1 1

quite satisfied 1.018 0.724 1.431 0.9183 1.319 0.981 1.773 0.7291 1.508 0.792 2.871 0.2114 1.050 0.679 1.626 0.8258 full satisfied 0.961 0.692 1.334 0.8098 1.258 0.946 1.672 0.4329 1.545 0.827 2.887 0.1722 0.914 0.596 1.403 0.6821

Experience with GP Number of GP visits per year

Never or 1 time 1 1 1 1 2-3 times 0.808 0.521 1.252 0.3394 0.855 0.577 1.269 0.4378 1.137 0.469 2.759 0.7762 0.920 0.521 1.626 0.7741

> 3 times 0.848 0.547 1.316 0.4628 0.780 0.525 1.159 0.2196 1.263 0.520 3.063 0.6061 1.165 0.664 2.044 0.5946

Satisfaction for LHS Overall satisfaction

not satisf. at all 1 1 1 1 not very satisf. 0.524 0.229 1.199 0.1258 0.521 0.248 1.095 0.0852 1.892 0.230 15.585 0.5533 0.511 0.190 1.378 0.1848

quite satisfied 0.468 0.212 1.031 0.0596* 0.449 0.221 0.914 0.0272* 2.079 0.265 16.279 0.4858 0.525 0.207 1.335 0.1761

very satisficed 0.394 0.180 0.862 0.0198* 0.393 0.195 0.796 0.0094* 1.032 0.130 8.187 0.9763 0.533 0.212 1.341 0.1813

full satisfied 0.314 0.103 0.961 0.0425* 0.275 0.103 0.731 0.0096* 1.325 0.110 15.994 0.8249 0.611 0.168 2.225 0.4547 Knowledge about LH services

not satisf. at all 1 1 1 1 not very satisf. 0.980 0.606 1.584 0.9346 1.171 0.759 1.806 0.4748 0.678 0.311 1.479 0.3291 0.858 0.482 1.526 0.6017 quite satisfied 1.123 0.692 1.823 0.6374 1.473 0.954 2.274 0.0804 0.617 0.277 1.376 0.2381 0.782 0.433 1.412 0.4145 very satisficed 1.148 0.555 2.375 0.7098 1.867 0.993 3.510 0.0626 0.852 0.241 3.012 0.8038 0.637 0.232 1.750 0.3819 full satisfied 0.452 0.089 2.309 0.3402 0.717 0.180 2.850 0.6364 <0.001 <.001 >999.999 0.9861 0.910 0.177 4.686 0.9102

Experience with LHS Return to LHS offices

never 1 1 1 1

sometimes 1.291 0.893 1.867 0.1750 0.999 0.439 2.273 0.9985 0.776 0.378 1.590 0.4880 0.854 0.505 1.445 0.5568 always 2.152 0.953 4.864 0.0653 1.514 1.102 2.080 0.0106* 0.946 0.203 4.411 0.9440 2.712 1.111 6.625 0.0285*


92% of e-health users

said that they

DISCUSS

WITH THE GP

what they find

on the Internet.

Results | The outcome of e-health use

Illustration by Keith Negley


Factor/characteristic Report to GP the e-health findings

Satisfaction for GP

Explanations not satisfied 1

quite satisfied 0.518 0.133 2.018 0.3432

full satisfied 0.520 0.129 2.092 0.3572

Participation not satisfied 1

quite satisfied 5.664 2.091 15.340 0.0006*

full satisfied 3.460 1.344 8.912 0.0101*

Suggestions about life style not satisfied 1

quite satisfied 1.214 0.699 2.107 0.4919

full satisfied 2.687 1.446 4.993 0.0018*

Experience with GP

Number of GP visits per year Never or one time 1

2-3 times 0.739 0.369 1.481 0.3940

more than 3 times 1.386 0.665 2.888 0.3840

Satisfaction for LHS

Overall satisfaction not satisfied at all 1

not very satisfied 2.516 0.685 9.243 0.1645

quite satisfied 1.563 0.464 5.259 0.4709

very satisficed 2.088 0.615 7.088 0.2376

full satisfied 6.264 0.522 75.224 0.1480

Knowledge about LHS not satisfied at all 1

not very satisfied 1.057 0.450 2.479 0.8994

quite satisfied 1.049 0.449 2.450 0.9119

very satisficed 0.461 0.147 1.445 0.1843

full satisfied >999.999 <0.001 >999.999 0.9889

Experience with LHS

Return to LHS offices due to

inefficiencies/similar

never 1

sometimes 1.028 0.533 1.984 0.9791

always 1.487 0.307 7.201 0.9791


E-health and relationship with GP

Patients and e-health users INVOLVE THEIR OWN GP about what they find on the internet MORE IF THEY FEEL MORE INVOLVED by their own GP about decisions related to their healthcare and wellness (life-style).


Some conclusions

Who is the health-information seeker online?

E-health user: young, literate and healthy.

A problem of EQUITY... or an OPPORTUNITY for a tailored

communication and health literacy and for the promotion of

new media?


Some conclusions

Are SATISFACTION and EXPERIENCE of

primary care determinant factors of e-health?

YES, but only satisfaction and experience of LOCAL

HEALTH CARE!

Satisfaction and experience of the GP are significant

determinants not of e-health use, but only of e-health

outcome…


Some conclusions

Does e-health damage the relationship

patient-general practitioner?

NO, if the patient is satisfied for the previous relationship with

the GP.

NO, if the GP involves the patient in the decisions about

healthcare and wellbeing.

NO, if the patient-EMPOWERMENT process stars in the

ambulatory of the GP.


Some conclusions

Sabina De Rosis | [email protected]