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Researchers examine use of the Internet, E-mail, and telephone triage for medical advice

How Americans communicate with their doctors and obtain medical information has changed dramatically. Many of the two-thirds of U.S. adults with Internet access use the Internet for medical information. Many more would like to E-mail their doctors for advice, prescription refills, and other matters. A growing number of patients also receive after-hours advice from nurses at telephone-triage centers. The following two studies, which were supported by the Agency for Healthcare Research and Quality (HS10604), examined use of the Internet, E-mail, and telephone triage for medical advice.

Baraff, L.J., Wall, S.P., Lee, T.J., and Guzy, J. (2003, July). "Use of the Internet and E-mail for medical advice and information by parents of a university pediatric faculty practice." Clinical Pediatrics, pp. 557-560.

This survey of a sample of parents who brought their children to a university-affiliated pediatric practice for care found that 91 percent of them had Internet access, and 87.5 percent had an E-mail address. About half used the Internet for medical information, and about 30 percent used it to get information about a specific acute or chronic medical illness.

Only 15 percent had communicated with a physician by E-mail in the past year. However, an additional 49 percent indicated that they would like to communicate with their physicians by E-mail. Three-quarters were willing to receive information about well child care and general health newsletters from the pediatric group practice by E-mail.

Parents more often rated physician telephone advice very good or excellent than nurse practitioner telephone advice (76 vs. 56 percent). Only 47 percent considered Internet information about a specific illness to be very good or excellent. About 70 percent would like to be able to ask their doctor medical-related questions by E-mail, make appointments, request prescription refills, and receive test results online. However, doctors do not currently use E-mail with their patients due to a perceived increase in workload and issues of patient confidentiality.

Lee, T.J., Baraff, L.J., Guzy, J., and others (2003, July). "Does telephone triage delay significant medical treatment?" Archives of Pediatric and Adolescent Medicine 157, pp. 635-641.

By the end of 1996, telephone triage services were available to 35 million people and were expected to reach 100 million people by the end of 2001. Call centers in which specially trained nurses provide medical advice using standardized protocols have the potential to improve the quality of advice and reduce the demand for health care services, according to this study. It found that the level of triage advice to parents from on-call pediatricians and advice nurses was remarkably similar, and that neither type of telephone advice delayed significant medical treatment (treatment that, if delayed, could potentially result in significant problems).

The investigators randomly assigned 1,182 calls to a university-affiliated general pediatrics practice to on-call pediatricians (566) or advice nurses (616) at a large telephone triage service. They classified advice as emergency department (ED) or urgent care (call 911, go to the ED, or obtain urgent care); office care (visit a doctor's office within 72 hours), and self-care. They conducted followup telephone interviews with callers 72 to 96 hours after the initial advice call about the advice they received and any health care visits made within 72 hours of the call.

The types of telephone triage advice given by the physician and advice nurse groups were not significantly different. There was no significant difference in the proportion of callers in each group who sought unadvised care (20 percent). Only 4 percent of patients in both groups received significant treatment after seeking unadvised care (most often a prescription for antibiotics).

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