SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
January, 2017 - SUPPORT Summary of a systematic review | print this article | download PDF
The use of email as a medium for business and social communication is increasingly common. Healthcare professionals have been communicating via email since the early 1990s, for varying purposes. However, it is not clear what the impacts of emails in healthcare are when compared to other forms of communicating clinical information.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
The use of email as a medium for communication might have several advantages, such as timely and low-cost delivery of information in comparison to other types of written communication, but it may also have disadvantages, such as concerns regarding privacy and potential misuse of information and increased workload.
| Review objectives: To assess the effects of healthcare professionals using email to communicate clinical information compared to other forms of communicating clinical information | ||
| Type of | What the review authors searched for | What the review authors found |
|---|---|---|
| Study designs & interventions | Randomised trials, non-randomised trials, controlled before-after studies, and interrupted time series studies evaluating email for two-way clinical communication between healthcare professionals |
One randomised trial evaluating an electronic medical record reminder delivered to primary care physicians compared to a control group (usual care pathway) |
| Participants | All healthcare professionals originating the email communication, receiving the email communication, or copied into the email communication |
Women aged 50 to 89 who had suffered a fracture and had not received bone mineral density measurement or medication for osteoporosis |
| Settings | Any setting, including primary care settings, outpatient clinics, community settings (public health settings), and hospital settings |
Non-profit, health maintenance organisation in the USA |
| Outcomes | Healthcare professional outcomes, patient outcomes and health service outcomes associated with whether email has been understood and acted upon correctly by the recipient as intended by the sender, and harms (e.g. effects on safety or quality of care, breaches in privacy, technology failures) |
Health professional practice (whether the care provider ordered the test and/or prescribed the recommended medication); patient outcomes (women’s calcium intake, regular activity and calorific expenditure), and satisfaction with care and services received. Health service outcomes and harms were not reported in the study. |
| Date of most recent search: November 2013 | ||
| Limitations: This is a well-conducted systematic review with only minor limitations | ||
Goyder C, Atherton H, Car M, et al. Email for clinical communication between healthcare professionals. Cochrane Database Syst Rev 2015; 2: CD007979.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
The review found only one study, evaluating primary care providers who received patient-specific email reminders for their enrolled patients from the chairman of the osteoporosis quality-improvement committee, and then a reminder after 3 months in case they had not ordered a bone mineral density test or prescribed pharmacological osteoporosis treatment for their patients.
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Email reminders compared to usual care |
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People Health professionals managing female patients aged 50 to 89 Settings A health maintenance organisation in the USA Intervention Email reminder Comparison Usual care |
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Outcomes |
Absolute effect* |
Relative effect (95% CI) |
Certainty of the evidence (GRADE) |
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Without |
With |
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Patients receiving bone mineral density measurement or osteoporosis medication |
59 per 1000 |
516 per 1000 |
RR 8.69 (5.04 to 12.27) |
Low |
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Difference: 457 more per 1000 (Margin of error: 240 to 670 more) |
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Health services outcomes |
No included studies |
- |
- |
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Harms |
No included studies |
- |
- |
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Margin of error = Confidence interval (95% CI) RR: Risk ratio GRADE: GRADE Working Group grades of evidence (see above and last page) * The risk WITHOUT the intervention is based on the risk in the control group of the studies identified in the review. The corresponding risk WITH the intervention (and the 95% confidence interval for the difference) is based on the overall relative effect (and its 95% confidence interval). |
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| Findings | Interpretation* |
|---|---|
| APPLICABILITY | |
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The identified study evaluated one of the many potential uses of email communication for one specific condition. The use of email as a medium for communication is increasingly common in low-income countries. However, email availability, technology, and regulations affecting the use of email, and health system constraints may limit the applicability of the findings of this study. |
| EQUITY | |
| The study did not directly address equity. |
Email communication might increase health inequities, disfavouring settings where access to email is reduced or restricted. However, email is widely available and low-cost in comparison with other types of communication, so it might decrease health inequities, particularly in remote areas. |
| ECONOMIC CONSIDERATIONS | |
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Email reminders may decrease costs compared with other types of reminders. |
| MONITORING & EVALUATION | |
| Only one study (in one setting in a high-income country) was found that addressed a specific use of email communication - for a problem that may not be a priority in low-income countries. |
Consideration should be given to monitoring both intended and unintended outcomes of changes in policy or the use of email for communication between healthcare professionals. There is need for additional randomised trials evaluating email reminders in other settings and for other conditions. There is need for additional randomised trials evaluating email for other types of communication between healthcare professionals. |
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*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods |
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Atherton H, Sawmynaden P, Sheikh A, et al. Email for clinical communication between patients/caregivers and healthcare professionals. Cochrane Database Syst Rev 2012; 11: CD007978.
Atherton H, Sawmynaden P, Meyer B, Car J. Email for the coordination of healthcare appointments and attendance reminders. Cochrane Database Syst Rev 201; 8: CD007981
Meyer B, Atherton H, Sawmynaden P, Car J. Email for communicating results of diagnostic medical investigations to patients. Cochrane Database Syst Rev 2012; 8: CD007980.
Sawmynaden P, Atherton H, Majeed A, Car J. Email for the provision of information on disease prevention and health promotion. Cochrane Database Syst Rev 2012; 11: CD007982.
Shojania KG, Jennings A, Mayhew A, et al. The effects of on-screen, point of care computer reminders on processes and outcomes of care. Cochrane Database Syst Rev 2009; 3: CD001096.
Gabriel Rada, Health Policy and Systems Research Unit, P. Universidad Católica de Chile
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Yannis Pappas and Airton Stein.
Goyder C, Atherton H, Car M, et al. Email for clinical communication between healthcare professionals. Cochrane Database Syst Rev 2015; 2: CD007979.
Rada G. Can email communication between health professionals improve healthcare? A SUPPORT Summary of a systematic review. January 2017. www.supportsummaries.org
Keywords
evidence-informed health policy, evidence-based, systematic review, health systems research,
health care, low and middle-income countries, developing countries, primary health care
email, communication, information technology
This summary was prepared with additional support from:
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The Health Policy and Systems Research Unit (UnIPSS) is a Chilean research collaboration for the generation, dissemination and synthesis of relevant knowledge about health policy and systems based at the School of Medicine of the P. Universidad Católica de Chile. |
