Access to the Internet and Mobile Applications in a Mixed Population Emergency Department: A Repeated Cross-Sectional Survey (Preprint)

Abstract

Electronic media can be used to help address the communication gaps that exist between doctors and patients. Prior to utilizing these tools within an emergency department with patients of various socioeconomic statuses, it was important to collect data regarding patient accessibility to the internet, email, and other health management applications.

The survey was conducted in 2014 and repeated in 2019 to identify trends in patients’ access to and use of the internet. We sought to assess the degree of interest in education content delivered through electronic modalities.

This anonymous, prospective, cross-sectional survey included 50 questions and was completed by 241 English and Spanish-speaking patients in 2014. 253 additional surveys were collected in 2019. Participants were surveyed at the University of California, Irvine Medical Center’s Emergency Department (UCIMCED) while patients were waiting for treatment and diagnostic tests. The primary outcome was to compare internet access and communication technology use between 2014 and 2019. Secondary goal was to compare the pattern of internet use and search for health information between 2014 and 2019 among patients who presented to the UC Irvine Emergency Department.

The vast majority of patients have access to the internet, with 83.8% (N=241, 95%, CI: 78.5% - 88.2%) having access in 2014, and this number increasing to 88.1% (N= 253, 95%, CI: 83.5% - 91.9%) in 2019 (P=.160). Most internet-using patients owned a smartphone in 2014 (N= 161; 80.1%), increasing almost 10% by 2019 (N=200; 89.7%). When searching for health-related information, 32.5% of patients could always find pertinent health information and 20.6% found this information always reliable. In addition, patients reported using electronic devices to obtain more information on their health, including Fitbits, activity trackers, and blood pressure cuffs. Among a range of electronic modalities patients can use to communicate with their healthcare provider, patients felt most comfortable receiving discharge instructions via email in 2014 and 2019.

The implications of this study can be used to develop electronic resources tailored to educate emergency department patients about their healthcare beyond the confines of a hospital. Given that as of 2019 88.1% of patients in our emergency department have access to the internet or email, electronic media is a reasonable venue for patient education. Given that we have a predominantly low-income patient population, with 61% of respondents reporting an income of less than $25,000, these results are valuable and provide new ways to reach patients of all socioeconomic statuses.