A content analysis of email consultations between general practitioners and patients in two general practices

Problem

Early adopter GPs are experimenting with the use of email for consulting with patients. Existing research reports GPs and patients perspectives on using email consultation but there is a lack of research about the content of these communications in the UK. Content analyses of GP-patient emails in primary care in the US found no evidence to support clinicians’ worries about how patients used email consultation e.g. clinician fears about being overwhelmed with emails were not realised. However, there are numerous differences between the US and UK health systems which challenge assumptions that the experience translates across. We are conducting the first UK-based content analysis of email consultations in two general practices.

Approach

Each participating practice has provided 50 email exchanges between GPs and patients. Email exchanges are fully anonymised. Patients were invited to opt out of having their emails included, but none did so. We have also collected (separately from email content) the age and gender of the patients with each email, and age, gender and year of qualification for GPs, along with information on how they use the email consultation with patients. We are applying content analysis to explore and delineate the type of clinical content in the emails, number of emails in exchange and the time at which emails are sent and responded to. We aim to explore the feasibility of this method with a view to applying it in larger scale studies of email consultation.

Findings

In each participating practice it was a single GP who was offering email consultation to patients and it was not available to all patients across the practice. Both GPs were male and had used email with patients for five years, and both offered patients ‘informal advice’ on how to use email for consultation rather than a protocol for use. In the first instance we are categorising emails as to whether they contain administrative and/or clinical content, whether safety concerns are expressed by either party, whether they use attachments (e.g. images, audio), the number of emails in each exchange and the time of day they were sent and responded to, both by patients and GPs. We are qualitatively analysing the content and our initial observations are around the distinction between emails that offer information (both parties) and emails that request a specific action. The study will complete by April 2016.

Consequences

Information on the content of email consultation is valuable in determining how it might work more widely across general practice. This will have utility for researchers who wish to find out more about the impact of email consultation in general practice, and for general practices that are considering the adoption of email consultation in general practice.