JMIR Publications

ABSTRACT

Background:

E-consultation enables patients to communicate with doctors about the symptom, development, treatment, and other information on their diseases. E-consultation is expected to improve the information level of patients, affect patients’ subsequent judgments of medical services, and become one of the means to guide patients to make a reasonable medical selection in the future. However, e-consultation use is low at this stage, and research on its influence mechanism on patients’ medical selection is also limited. Thus, the procedure of how to effectively apply e-consultation to guide patients to seek reasonable medical services is still unsatisfactory.

Objective:

To explore the changes in first-visit patients’ understanding of disease and medical resources after e-consultation, as well as the choice of follow-up medical services.

Methods:

Based on the expected utility theory, information asymmetry theory, and advantageous selection theory, the theoretical hypothesis that e-consultation affects first-visit patients’ medical selection was developed. The patients’ medical selection before and after e-consultation was compared using a scenario survey. Based on the service characteristics of the e-consultation platform, representative simulation scenarios were determined, and parallel control groups were set up considering the order effect in comparison. Finally, a total of four scenario simulation questionnaires were designed. A total of 4,164 valid questionnaires were collected through the online questionnaire collection platform. Patients’ perception of disease severity, evaluation of treatment capacity of medical institutions, selection of hospitals and doctors, and other outcome indicators were tested to analyze the differences in patients’ evaluation and choice of medical services before and after e-consultation. Additionally, the results’ stability was tested by regression analysis.

Results:

In the mild cases, before e-consultation, only 14.4% of patients considered their conditions as not serious. After e-consultation, 71.5% considered their diseases as mild, and participants’ evaluation of the disease treatment capacity of medical institutions at all levels had improved. In the severe cases, before e-consultation, 55.4% of the participants believed their diseases were very serious. After e-consultation, 25.1% considered their diseases were very serious. The evaluation of disease treatment capacity of medical institutions in non-tertiary hospitals decreased, whereas that of tertiary hospitals was improved. In both the mild and severe cases, before e-consultation, all of the participants were inclined to directly visit the hospital. After e-consultation, more than 70% of the mild patients chose self-treatment, whereas the severe cases still opted for a face-to-face consultation. After e-consultation, patients who were set on being treated in a hospital, regardless of the disease severity, preferred to select the tertiary hospitals. Of the mild patients who chose to go to a hospital, 28.6% wanted to consult online doctors face-to-face. In contrast, 59.3% of the severe cases wanted to consult online doctors face-to-face.

Conclusions:

E-consultation can help patients accurately enhance their awareness of the disease and guide them to make a more reasonable medical selection. However, it is likely that e-consultation makes online medical services centralized. Additionally, the guiding effect of e-consultation is limited, and e-consultation needs to be combined with other supporting systems conducive to medical selection to play an improved role.