Email consultations between patients and doctors in primary care: a content analysis

Background: Increasingly consultations in healthcare settings are carried out remotely, using a range of communications technologies. Email allows for a two-way text based communication, occurring asynchronously. Studies have explored the content and nature of email consultations as a way to understand the use, structure and function of email consultation. The majority of previous content analyses of email consultation in primary care settings have been conducted in North America and these have shown that concerns and assumptions about how email consultation might work have not been realised. There has not been a United Kingdom (UK) based content analysis of email consultations.
Objectives: To explore and delineate content of consultations conducted via email in English general practice, by conducting a content analysis of email consultations between General Practitioners (GPs) and patients.
Methods: We conducted a content analysis of anonymised email consultations between GPs and patients in two general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when emails were sent, how many emails were in an email consultation and the nature of the content. We used a normative approach to analyse the content of email consultations to explore the use of and function of email consultation.
Results: We obtained 100 email consultations from 85 patients, this totalled 262 individual emails. The majority of email users were aged over 40 and over half of users were male. Email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. Emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were three key themes to the use and function of the email consultations; the role of the GP and email consultation, the transactional nature of an email consultation and the operationalisation of email consultation.
Conclusions: Where email is used to have a consultation with a patient in general practice in the majority of cases the consultation is short, clinical in nature and resolved quickly. GPs approach email consultation using similar key elements of the face-to-face consultation, however, using email consultation has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultation was not a replacement for a face-to-face consultation.