JMIR Publications

ABSTRACT

Background:

The growth of electronic medical records and patient portal use have allowed for patients and health care providers to communicate by e-mail and direct messaging between health care visits. E-mail patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared-decision making, and confirm understanding in between in-person visits. Despite increasing trends in the use of e-mail patient-provider communication (PPC) since the early 2000s, few studies have evaluated associations between e-mail PPC and preventive services uptake.

Objective:

Our objective was to determine associations between e-mail PPC use and adults’ likelihood of receiving breast, cervical, and colon cancer screenings.

Methods:

Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed (n=68,691). For each cancer screening, inclusion criteria were based on the age of screening recommendations and no prior history of the cancer screening of interest. The independent variable was whether adults used e-mail PPC in the past 12 months (yes or no). The dependent variables were whether: 1) women received a mammogram in the past 12 months (ages >40 years); 2) women received a Pap test in the past 12 months (ages 21-65 years); and 3) adults received a colon cancer screening in the past 12 months (ages >50 years). Bivariate and multivariable logistic regression analyses were conducted.

Results:

Adults who reported receiving all cancer screenings in the past 12 months were more likely to be non-Hispanic white, married/live with a partner, have a bachelor’s degree or higher level of education, have health insurance coverage and perceive their health as excellent, very good or good (all p’s<.001). Men were more likely to receive colon cancer screenings than women (p<.0001). In multivariable logistic regression models, women who used e-mail to communicate with their health care providers had greater odds of receiving breast (OR=1.38; 95% CI=1.26-1.50) and cervical (OR=1.10; 95% CI=1.02-1.20) cancer screenings compared to women who did not use e-mail PPC. Adults who used e-mail to communicate with their health care providers had 1.55 times greater odds (95% CI=1.42-1.69) of receiving a colon cancer screening compared to those who did not use e-mail PPC.

Conclusions:

Our results demonstrate that more patient engagement through health information technology for communication with health care providers may improve adults’ likelihood of receiving preventive services, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of e-mail PPC between patients and health care providers and determine avenues for health education and intervention.