- The patient-provider relationship built within the office setting may have a bigger impact on patient satisfaction scores than patient-provider communication outside of the office setting, says a new report out of the Regenstrief Institute obtained via email.
The evolving ways by which providers communicate with their patients – secure message, email, phone call – have had an impact on patient care. Patients, who report a need for strong connections with their providers, have been turning to digital tools to support better patient-provider relationships.
But those digital technologies have raised some concerns for providers. Adherence to HIPAA regulations and a clear boundary in the patient-provider relationship has caused some providers to pause before handing out their email address or personal cell phone number.
“The use of cellphone, email and texting by providers to communicate with patients exists in a regulatory gray zone in many medical institutions,” said Joy L. Lee, PhD, the author of the paper and a part of the Regenstrief Institute's Center for Health Services Research. “Some institutions explicitly discourage their use for patient-provider communication while some professional societies have provided guidelines for the safe use of email and secure messaging in clinical practice.”
Conflicting patient demands and provider apprehensions have caused some clinicians to be judicious about the ways in which they maintain contact with their patients. However, little is known about how providers select patient-provider communication strategies and the impact those strategies have on patient satisfaction.
An assessment of provider communication habits and patient satisfaction scores at nearly 150 mid-Atlantic primary care providers revealed that the patient-provider relationship has a larger influence on patient satisfaction.
A majority of providers (63 percent) said that they spend between zero and five hours each week communicating with patients outside of the office. The remainder said they spend more than five hours weekly talking to patients.
Providers typically did not initiate conversations, but rather used communication methods to answer patient inquiries.
Forty-nine percent of providers used their cell phones for patient communication, 27 percent used their emails, and 2 percent used text messages.
Providers who offered their email addresses to patients (56 percent) were more likely to communicate with patients outside of the office than any other communication method. These providers also had statistically significant higher patient satisfaction scores compared to providers who did not offer their email addresses.
However, there was no statistical difference between individual patient satisfaction domains.
The analysis also revealed that offering a patient a line of communication was more so a symbol of a positive patient-provider relationship than an effort to improve patient access to the physician.
“A provider’s decision to email patients appears to rest largely upon the behavior of patients and their relationship with patients, rather than patient or provider characteristics,” Lee wrote in her report.
“Providers reported giving their email addresses to patients that they trust to understand the boundaries of the provider-patient relationship and many of those who email are colleagues or social peers within the same medical system,” she added. “Thus, the giving of an email address may represent more than the access itself, but a trusting and, oftentimes, peer relationship, and patients may be rating their satisfaction with their providers based on their relationship.”
Providers did express their concerns with digital patient communication. In addition to security issues, 81 percent of providers said they were concerned that patients wouldn’t understand a message. Eighty-two percent of providers said they were concerned they would miss an important message from a patient.
“Such issues highlight the unpredictability of asynchronous messages - by communicating at different times rather than face-to-face or via the telephone, providers and patients may have a harder time assuring that they understand each other - and such concerns cannot be easily addressed by technological advances such as secure messaging,” Lee said.
These results indicate that providers need to reassess the role that communication tools play in the patient-provider relationship. Provider concerns are valid, Lee suggested, but it is also essential to allow patients access to providers using the means most convenient to patients.
The key to accomplishing this is through in-office conversations, Lee recommended.
"It's time that doctor and patient have a face-to-face conversation during an office visit explaining how each feels about electronic communication," she said in a statement. "Patients can discuss their electronic access and their comfort level with getting information electronically. Physicians can share their own concerns with patients."
Establishing a set of expectations for digital communication is the best strategy for yielding high patient satisfaction with the tools, Lee noted.
"The takeaway message about secure messaging? Physicians who have a stronger relationship with their patients and who let their patients know how to contact them either online or off may have better patient satisfaction than those who do not," she concluded. "This is a conversation doctors and their patients should have."