title: The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review.
abstract: BACKGROUND
  In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions.
  
  
  OBJECTIVE
  The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction.
  
  
  METHODS
  A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction.
  
  
  RESULTS
  Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes.
  
  
  CONCLUSIONS
  The effect of asynchronous communication is not shown unequivocally in these studies. Patients seem to be interested in using email. Patients are willing to participate and are taking the initiative to discuss health issues with their providers. Additional testing of the effects of asynchronous communication on self-management in chronically ill patients is needed.
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, Netherlands. c.c.dejong-8@umcutrecht.nl.
authors.forename: Catharina Carolina
authors.initials: CC
authors.lastname: de Jong
authors.forename: Wynand Jg
authors.initials: WJ
authors.lastname: Ros
authors.forename: Guus
authors.initials: G
authors.lastname: Schrijvers
mesh_terms: D001249:Asthma / Q000503:physiopathology / Q000628:therapy; D002908:Chronic Disease; D003142:Communication; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D015438:Health Behavior; D006801:Humans; D020407:Internet; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction; D011369:Professional-Patient Relations
keywords: Internet; chronic disease; delivery of health care; electronic mail; health services; medical informatics; self-care; self-efficacy; telecommunications; telemedicine