View source for The E-Patient-Provider Relationship

(Original Article from Clinfowiki: The E-patient-provider relationship: SMS, Blogs and the Patient-Provider Relationship: Enhancing Communication, Improving Treatment Outcomes).

Despite the various potential advantages outlined in the original article on use of SMS and blogs to improve patient-provider relationship and medical management, there are a lot of hurdles that will need further consideration.
For SMS which entails that the patient would have to send text messages directly to the provider, the following will need to be further considered:  availability of the provider, inappropriate use, reluctance on part of patients, acceptability, and problems with retrieving messages.

Availability of the provider

The provider needs to be available at all times to address patients’ concerns or designate a surrogate, when not available. This will not be practical for a provider that has a large panel size with thousands of patients.  In one study involving SMS in management of diabetes, it was noted that during the trial, patients sent an average of 33 messages per month1. This would translate to a significant, if not, overwhelming number of calls for the provider per month. 
Consequently, there will be need to reduce the panel size in order to provide optimal response and care to patients’ inquiries. This is reflective of “boutique medicine” where some providers choose to have a minimum number of patients in the practice with plans to improve access and optimize patients’ health care2. In this model, patients have 24-hour access to a mobile phone or pager. However, it comes with a price, since the providers have to ensure adequate revenue and remuneration to function. In such existing models, the medical practices are largely relegated to wealthy patients who are able to afford higher premiums for their health care and this group is not representative of the general population.  

Inappropriate use

There is the risk that patients may use SMS or blogs to report urgent or emergent concerns. For  instance, the study that was mentioned in the original article involved researchers in diabetes who used a text messaging service (Sweet Talk) with their teenage patients. In this scenario, there is the tendency that some patients may opt to send text messages to their providers for home blood glucose reading of >500 with associated symptoms, instead of seeking emergency care. Such messages may not be promptly retrieved by the provider to give immediate advice that could prevent undesirable outcomes. In conventional systems, where patients call the telephone line of their providers and are triaged by nursing staff, there is still a considerable number of such examples, including patients who would call to report symptoms of an acute nature related to chest pain or stroke; however, these messages are received and addressed by live personnel or staff who promptly direct the patients to seek emergency care or assist them in contacting the local Emergency Medical Service.

Reluctance on part of patients

Some patients may be reluctant to discuss sensitive symptoms or concerns using SMS or blogs and prefer face-to-face encounters with their health care providers. Even during clinic encounters, it is not unusual to find that some patients do not divulge the primary reason for the visit to the front desk staff and the nurse at triage, but would wait until they see the physician and feel comfortable after establishing a certain level of rapport.

Acceptability

Most studies on the use of SMS seem to be focusing on young patients, for instance, adolescents and teenagers with one medical condition, such as, asthma3. This group of patients tends to find the devices interactive, are more willing to accept newer technologies, and use SMS than elderly patients with several chronic illnesses who have limited exposure to evolving technology.

Retrieving messages

It may be challenging for the provider to store individual patient messages for reference and future care coordination when hundreds of patients are on a provider’s panel. While the patient is likely to recall specific concerns that were discussed one month ago, the provider would need to refer back to the text to obtain pertinent information on the patient or some notes they made for themselves to recall the plan of care or management. 
    
References

1. Ferrer-Roca O, Cardenas A, Diaz-Cardena A, Pulido P. Mobile phone text messaging in the management of diabetes. J Telemed Telecare Oct 1 2004, vol. 10: 5;282-285.
2. Russano J. Is Boutique Medicine a New Threat to American Health Care or a logical Way of Revitalizing the Doctor-Patient Relationship?
3. Neville R, Greene A, McLeod J, Tracy A, Surie J. Mobile phone text messaging can help young people manage asthma. BMJ. 2002 September 14; 325(7364):600.

Submitted by Agwu Onuoha

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