title: Electronic patient-provider communication: will it offset office visits and telephone consultations in primary care?
abstract: OBJECTIVE
  Electronic patient-provider communication promises to improve efficiency and effectiveness of clinical care. This study aims to explore whether a secure web-based messaging system is an effective way of providing patient care in general practices.
  
  
  METHODS
  We conducted a randomised controlled trail and recruited 200 patients from the waiting area in one primary clinic in Norway. Participants were randomised to either the intervention group, which received access to a secure messaging system, or the control group receiving standard care without such access. Primary outcome measures were number of online consultations, telephone consultations and office visits in the two groups. Data were derived from patient records and collected 1 year prior to (baseline), and 1 year after the intervention.
  
  
  RESULTS
  Forty-six percent of the patients who were given access to the messaging system (n=99) used the online communication system on at least one occasion (ranging from 1 to 17 messages per patient per year). A total of 147 electronic messages were sent to six general practitioners during a 1-year trial period. Eleven percent of the messages were to schedule an appointment. In 10% of the messages, the GP was unable to respond adequately and recommended an office visit. The reduction in office visits over time was greater for the intervention group than for the control group (P=0.034). There was however no significant difference in the number of telephone consultations between the groups during the study (P=0.258).
  
  
  CONCLUSIONS
  The use of a secure electronic messaging system reduced the number of office visits at the general practice, but not phone consultations.
authors.affiliation: Norwegian Centre for Telemedicine, University Hospital of North Norway, N-9038 Tromsø, Norway. trine.bergmo@telemed.no
authors.forename: Trine S
authors.initials: TS
authors.lastname: Bergmo
authors.forename: Per Egil
authors.initials: PE
authors.lastname: Kummervold
authors.forename: Deede
authors.initials: D
authors.lastname: Gammon
authors.forename: Lauritz Bredrup
authors.initials: LB
authors.lastname: Dahl
mesh_terms: D000328:Adult; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D009664:Norway / Q000453:epidemiology; D009819:Office Visits / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000706:statistics & numerical data*; D019114:Remote Consultation / Q000706:statistics & numerical data*; D013689:Telephone / Q000706:statistics & numerical data*