Abstract
Background: Electronic medical records and Web communications bring new opportunities to provide healthcare. Still unknown is whether this type of care will improve health outcomes and its affect on utilization and costs. Care in this environment may also be limited by the ‘digital divide’ between users and nonusers of Web communications. ‘Electronic Communications and Home Blood Pressure Monitoring (e-BP)’ is a randomized controlled trial designed to test the effectiveness of home BP monitoring, Web communications (secure patient e-mail that interfaces with an electronic medical record shared between patients and providers), and pharmaceutical care to improve hypertension control. We describe the proportions and characteristics of hypertensive patients willing and able to participate in an electronic healthcare intervention.
Methods: Patients with uncomplicated hypertension received mailed invitations, a telephone survey, and in-person visits to determine their eligibility and willingness to participate. Eligibility requirements included access to a computer, the Internet, and an e-mail address. We performed a cross-sectional study on the subset willing to answer the telephone survey (n=7286), evaluating demographic differences between three populations:
those ineligible due to at least one computer access reason;
those eligible based on computer access, but not enrolled in the study for other reasons; and
those eligible and enrolled.
We ran Pearson’s chi-square test to evaluate bivariate associations. All P-values were two-sided.
Results: Of those answering the telephone survey, 78% had computer, Internet, and e-mail access. These patients were significantly more likely to be male (P<0.001), younger (P<0.001), Caucasian (P=0.01), more educated (P<0.001), employed (P<0.001), and with a commercial healthcare plan (P<0.001), but no more likely to have a home BP machine. Enrolled patients with computer access and uncontrolled hypertension were not more likely to be male, but otherwise they were similar to those with computer access but not enrolled for other reasons.
Conclusions: Most patients we contacted with hypertension had computer, Internet, and e-mail access, but a ‘digital divide’ persists. Chronic disease disproportionately affects older people, racial minorities, and those with less education. If electronic healthcare is to be effective in improving chronic disease health outcomes, additional efforts will be required to include these patients.
- Received September 11, 2008.
