title: Patient-initiated e-mails to providers: associations with out-of-pocket visit costs, and impact on care-seeking and health.
abstract: OBJECTIVE
  To understand when patients use secure e-mail messaging with healthcare providers across several types of questions or concerns, associations between out-of-pocket costs for in-person visits and use of secure messaging, and to examine patient-reported impacts on care-seeking behavior and overall health.
  
  
  METHODS
  Cross-sectional survey of patients in an integrated healthcare delivery system, with access to a patient portal to send secure e-mail messages to providers at no out-of-pocket cost.
  
  
  METHODS
  The study included patients with a chronic condition (N = 1041). We described patient-reported preferences for contacting providers and patient-reported impact of e-mail use on phone calls, in-person visits, and overall health. We used multivariate analyses to examine patient characteristics associated with using e-mail as a first contact method, and effects on care-seeking and health.
  
  
  RESULTS
  Overall, 56% of patients sent their provider an e-mail within 1 year, and 46% reported e-mail as their first method of contact for 1 or more types of medical concerns. After adjustment, higher out-of-pocket costs for in-person visits were significantly associated with choosing e-mail as a first method of contact (P < .05). Among patients who had e-mailed their provider, 42% reported that it reduced their phone contacts, 36% reduced in-person office visits and 32% reported e-mailing improved their overall health.
  
  
  CONCLUSIONS
  Patients reported using e-mail broadly to initiate conversations with their providers, and patients with higher out-of-pocket costs for in-person visits were more likely to choose e-mail as a first contact method. Use of secure e-mails reduced patients' use of other types of healthcare and resulted in improved overall health.
authors.affiliation: Kaiser Permanente Division of Research, 2000 Broadway, Oakland, CA 94612. E-mail: Mary.e.reed@kp.org.
authors.forename: Mary
authors.initials: M
authors.lastname: Reed
authors.forename: Ilana
authors.initials: I
authors.lastname: Graetz
authors.forename: Nancy
authors.initials: N
authors.lastname: Gordon
authors.forename: Vicki
authors.initials: V
authors.lastname: Fung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology; D003430:Cross-Sectional Studies; D034742:Electronic Mail / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care; D011795:Surveys and Questionnaires; D013689:Telephone / Q000706:statistics & numerical data; D055815:Young Adult