title: Internet Services for Communicating With the General Practice: Barely Noticed and Used by Patients.
abstract: BACKGROUND
  The Netherlands is one of the frontrunners of eHealth in Europe. Many general practices offer Internet services, which can be used by patients to communicate with their general practice. In promoting and implementing such services, it is important to gain insight into patients' actual use and intention toward using.
  
  
  OBJECTIVE
  The objective of the study is to investigate the actual use and intention toward using Internet services to communicate with the general practice by the general practice population. The secondary objective is to study the factors and characteristics that influence their intention to use such services.
  
  
  METHODS
  There were 1500 members of the Dutch Health Care Consumer Panel, age over 18 years, that were invited to participate in this cross-sectional study. People who had contacted their general practitioner at least once in the past year were included. Participants were asked to fill out a questionnaire about the following services: Internet appointment planning, asking questions on the Internet, email reminders about appointments, Internet prescription refill requests, Internet access to medical data, and Internet video consultation. Participants indicated whether they had used these services in the past year, they would like to use them, and whether they thought their general practice had these services. For the first two services, participants rated items based on the unified theory of acceptance and use of technology complemented with additional constructs. These items were divided into six subscales: effort expectancy, performance expectancy, trust, attitude, facilitating conditions, and social influence.
  
  
  RESULTS
  There were 546 participants that were included in the analyses out of 593 who met the inclusion criteria. The participants had a mean age of 53 years (SD 15.4), 43.6% (n=238) were male, and 66.8% (n=365) had at least one chronic illness. Actual use of the services varied between 0% (n=0, video consultation) and 10.4% (n=57, requesting prescription refill by Internet). The proportion of participants with a positive intention to use the service varied between 14.7% (n=80, video consultation) and 48.7% (n=266, Internet access to medical data). For each service, approximately half indicated that they did not know whether the service was available. Univariate logistic regression analyses revealed that all the constructs as well as age, level of education, and Internet usage had a significant association with intention toward using Internet appointment planning and asking questions by Internet.
  
  
  CONCLUSIONS
  Internet communication services to contact the general practice are not yet frequently used by this population. Although a substantial number of persons have a positive intention toward using such services, not all people who receive primary care seem willing to use them. The lack of awareness of the availability and functionality of such services might play an important role.
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of Health Services Research, Maastricht University, Maastricht, Netherlands. m.huygens@maastrichtuniversity.nl.
authors.forename: Martine Wj
authors.identifier: http://orcid.org/0000-0002-5033-1399
authors.initials: MW
authors.lastname: Huygens
authors.forename: Joan
authors.identifier: http://orcid.org/0000-0002-0258-7525
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Roland D
authors.identifier: http://orcid.org/0000-0002-5602-826X
authors.initials: RD
authors.lastname: Friele
authors.forename: Onno Cp
authors.identifier: http://orcid.org/0000-0002-3016-1476
authors.initials: OC
authors.lastname: van Schayck
authors.forename: Judith D
authors.identifier: http://orcid.org/0000-0002-9549-9005
authors.initials: JD
authors.lastname: de Jong
authors.forename: Luc P
authors.identifier: http://orcid.org/0000-0002-3013-2640
authors.initials: LP
authors.lastname: de Witte
keywords: eHealth; general practice; online communication; primary care