Can the Use of Internet Hospitals Improve physician-patient relationship?: Cross-Sectional Study From Patients’ Perspective in China (Preprint)

Abstract

Internet hospitals, an innovative approach to outpatient service delivery via the Internet, are rapidly developing in China, especially in the current ongoing COVID-19 epidemic, with adequately fulfilling people’s demands for health services. However, despite a number of studies regarding internet hospitals, there has been little research that further evaluates the effect of internet hospitals on physician-patient relationship during outpatient visits.

The purpose of our study was to examine whether the use of internet hospitals improves physician-patient relationship and to find out the difference in physician-patient relationship between internet hospital users and nonusers (offline hospital users) during outpatient visits.

We developed a questionnaire based on the patient-doctor relationship questionnaire (PDRQ-9), a widely used tool for measuring the physician-patient relationship, to survey physician-patient relationship. The random sampling technique was used to include respondents who used medical services in offline physical or internet hospitals in the past 12 months. Chi-square tests were employed to compare the different categorical characteristics between internet hospital users and nonusers (offline hospital users). T tests were used to test the significance in continuous variables between user scores and nonuser scores in physician-patient relationship. Multiple linear regression was performed to determine whether the use of internet hospitals during outpatient visits was associated with physician-patient relationship.

A total of 505 valid responses were received from patients, and 25.7% (130/505) reported that they had sought for medical services in internet hospitals in the past 12 months. Internet hospital users gave significantly lower scores than nonusers in total physician-patient relationship scores (t503=-2.610, P=.010), and the 5 items of “My physician helps me” (t503=-4.176, P<.001), “I trust my physician” (t503=-3.228, P=.001), “My physician understands me” (t503=-3.330, P=.001), “My physician and I agree on the nature of my medical symptoms” (t503=-2.460, P=.015), and “I can talk to (communicate with) my physician freely” (t503=-2.573, P=.011). After controlling for other factors, the analysis of multiple linear regression showed that the use of internet hospitals decrease the patient-doctor relationship scores by 12.0%. Results from the study also found that the age (β=-.107, P=.022) and the self-rated health status (β=2.047, P<.001; β=4.828, P<.001, respectively) influenced the patient-doctor relationship as well. Patients who used internet hospitals, those with higher age, and those who rated their health worse were more likely to have a worse physician-patient relationship during outpatient visits.

The use of internet hospitals could not improve but decrease the physician-patient relationship during outpatient visits. Internet hospitals as an important supplement to conventional physician-patient relationship, policy makers should pay attention to the improvement of physician-patient relationship when devoted to the development of internet hospitals.