international journal of medical informatics 78 ( 2 0 0 9 ) 688–703 journal homepage: www.intl.elsevierhealth.com/journals/ijmi Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation Nicol Nijland a,* , Julia E.W.C. van Gemert-Pijnen a , Henk Boer a , Michaël F. Steehouder b , Erwin R. Seydel a a Department of Psychology and Communication of Health and Risk, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands b Department of Technical and Professional Communication, Faculty of Behavioural Sciences, University of Twente, Enschede, The Netherlands article info Article history: Received 12 February 2009 Received in revised form 16 June 2009 Accepted 20 June 2009 Keywords: Internet E-mail Consultation Patient-provider communication Primary care abstract Objective: To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users). Methods: We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience. Results: In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to deter- mine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups – the elderly, the less-educated individuals, the chronic med- ication users and the frequent GP visitors – were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients. Conclusion: In order to foster the use of e-consultation in primary care both GPs and non- users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their ∗ Corresponding author at: Department of Psychology and Communication of Health and Risk, Faculty of Behavioural Sciences, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. Tel.: +31 651071559; fax: +31 534894259. E-mail address: n.nijland@utwente.nl (N. Nijland). 1386-5056/$ – see front matter © 2009 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2009.06.002