Physicians' use of email with patients: factors influencing electronic communication and adherence to best practices.
BACKGROUND
With the public's increased use of the Internet, the use of email as a means of communication between patients and physicians will likely increase. Yet, despite evidence of increased interest by patients, e-mail use by physicians for clinical care has been slow.


OBJECTIVE
To examine the factors associated with physician-patient e-mail, and report on the physicians' adherence to recognized guidelines for e-mail communication.


METHODS
Cross-sectional survey (March-May, 2005) of all primary care physicians (n = 10253), and a 25% stratified, random sample of all ambulatory clinical specialists (n = 3954) in the state of Florida. Physicians were surveyed on email use with patients, adherence to recognized guidelines, and demographics.


RESULTS
The 4203 physicians completed the questionnaire (a 28.2% participation rate). Of these, 689 (16.6%) had personally used e-mail to communicate with patients. Only 120 (2.9%) used e-mail with patients frequently. In univariate analysis, e-mail use correlated with physician age (decreased use: age > 61; P = .014), race (decreased use: Asian background; P < .001), medical training (increased use: family medicine, P = .001; or surgical specialty, P = .007; but not internal medicine, P = .112), practice size (> 50 physicians, P < .001), and geographic location (urban 17.2% vs. rural, 7.9%; P < .001). Multivariate modeling showed that only practice size greater than 50 (OR = 1.94; 95% CI = 1.01-3.79) and Asian-American race (OR = 0.26; 95% CI = 0.14-0.49) were related to e-mail use with patients. Remarkably, only 46 physicians (6.7%) adhered to at least half of the 13 selected guidelines for e-mail communication.


CONCLUSIONS
This large survey of physicians, practicing in ambulatory settings, shows only modest advances in the adoption of e-mail communication, and little adherence to recognized guidelines for e-mail correspondence. Further efforts are required to educate both patients and physicians on the advantages and limitations of e-mail communication, and to remove fiscal and legal barriers to its adoption.
Florida State University, College of Medicine, Division of Health Affairs, 1115 W. Call Street, Tallahassee, Florida 32306-4300, USA. Robert.Brooks@med.fsu.edu
Robert G
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Brooks
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D001292:Attitude to Computers; D003142:Communication; D003195:Computer Communication Networks / Q000331:legislation & jurisprudence / Q000592:standards*; D016494:Computer Security / Q000592:standards; D003219:Confidentiality / Q000331:legislation & jurisprudence; D003430:Cross-Sectional Studies; D034742:Electronic Mail / Q000458:organization & administration*; D005260:Female; D005431:Florida; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations