Pediatric Caregiver Attitudes and Technologic Readiness Toward Electronic Follow-Up Communication in an Urban Community Emergency Department

Introduction

The Institute of Medicine recommends that “patients should receive care whenever they need it and in many forms, not just face to face visits” and that “access to care should be provided over the Internet.” ¹ Additionally, the U.S. Department of Health and Human Services recommends developing evidence on the effectiveness of health text-messaging programs. ² Electronic methods have potential to increase communications and to improve the quality and efficiency of care. Existing research has largely focused on adult populations. ³ A review of cell phone use for healthcare suggests that communication technologies can improve health outcomes and processes of care. ⁴ A study conducted with parents who have used e-mail to communicate with their child's pediatrician found that 98% of parents were very satisfied with their experience. ⁵ However, there exists concern that unequal access to these technologies could create inequities in care.

We hypothesize that parents bringing their children to an urban emergency department (ED) have access to cell phones, text messaging, Internet, and e-mail and would be interested in follow-up communications with their healthcare providers by these modalities. The objective of this study is to document pediatric caregiver attitudes toward and access to these technologies in an urban community ED setting.

Subjects and Methods

Results

One hundred thirteen caregiver–child dyads were approached; 10 declined participation, and 1 survey was completed by a teen without a parent, to yield a response rate of 90% (n=102). The mean age of caregivers was 33 years (range, 18–64 years); the mean age of the child being seen was 5½ years (range, 0–17 years). The majority were mothers (75%), with the remainder as fathers (17%), grandparents (4%), or other (4%). Over half (64%) reported a household income less than $40,000 annually (Table 1). Caregivers reported home access to the Internet (72%) and cell phone ownership (90%), with more caregivers reporting daily text messaging (87%) than daily e-mail (46%). The majority of caregivers (70%) agreed that doctors should offer e-mail as a communication option and would be comfortable with ED providers e-mailing their child's pediatrician (Table 2).

Discussion

Most caregivers in our urban population have access to modern communication technologies and are interested in communicating with their emergency providers by these modalities. Cell phone and text-messaging technologies appear to be more available than Internet and e-mail in our largely urban underserved population and may serve as an underutilized contact method. Although a greater percentage of respondents reported owning a cell phone, more were interested in asking questions of their provider through e-mail than text messaging. It may be that text messaging is better suited for briefer exchanges because of the nature of entering text. Less than half of respondents expressed interest in receiving test or x-ray results via text message, whereas 63% said they would be willing to receive these results via e-mail. A prior study found that it is feasible to deliver culture results through a secure Web site. ⁶ However, questions concerning privacy and security issues remain unanswered, and established national guidelines are currently lacking.

Our study found levels of Internet and cell phone usage consistent with a recent report detailing Internet and cell phone use among African-American women attending a sexually transmitted infection clinic in Baltimore. ⁷ These findings run contrary to reports concerning Internet use among lower socioeconomic groups and ethnic minorities published only a few years ago, mitigating concerns that expanding the use of electronic communication between patients and providers would widen healthcare disparities. The majority of caregivers have access to one or both of these technologies, and a significant number want to be able to use e-mail or text messaging to communicate with their provider.

Follow-up of patients after an ED visit is important for monitoring changes in patient health and informing patients of the results of tests conducted during their visit. The telephone remains the standard method of communication with patients after an ED visit despite contact rates around 50% for adult patients ⁸ and only slightly higher rates for pediatric patients. ⁹ Others have compared e-mail with telephone contact without showing a benefit. ^10,11 Further research should investigate which communication modalities are best suited for conveying specific information, such as test results, or determining need for return to the ED while taking into consideration the inherent ethical and privacy concerns raised by all forms of communication. ^12,13

Study limitations include the small sample size and cross-sectional design. The sample was too small for subgroup analysis. Other limitations include selection bias from our convenience sample during evening hours. Lastly, our survey instrument lacks formal testing for reliability and validity.

Conclusions

Caregivers of children in an urban community ED have access to the Internet and mobile phone technologies and would be interested in communicating with healthcare providers following an ED visit. Future studies should determine if electronic methods of contact could improve follow-up care of pediatric patients after acute care visits.