The inverse care law and the use of e-consultation

August 3, 2009

I have read Nijland, N., van Gemert-Pijnen, J. E. W. C., Boer, H., Steehouder, M. F., & Seydel, E. R. (2009). Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation. International Journal of Medical Informatics, In Press, Corrected Proof.


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).

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.


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 determine 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 medication 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.

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 specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.

Summary points

What was already known on the topic?

  • The increased public interest in medical information regarding health issues are driving forces for the growth of health services on the Internet. However, the growth of e-consultation in primary care has been minor.
  • Access to healthcare and information technology is often most difficult for those populations who need it most. E-consultation can be beneficial for certain patient groups, such as frequent GP visitors and chronic users of medication. Yet, it is unclear whether access to e-consultation is most difficult for these populations.

What did this study add to our knowledge?

  • Non-use of e-consultation was primarily due to lack of availability among GPs and to information deficits among patients, such as unawareness of the existence of the service and the possibilities of e-consultation. Proper education and instructions are necessary to increase the use of e-consultation.
  • Patient groups who were most motivated to use e-consultation e.g., elderly patients, less-educated patients, chronic medication users and frequent GP-visitors, perceived the greatest barriers towards econsultation.
  • Web-based triage systems may be promising, because this study indicates that patients are motivated to use such systems for primary evaluation of medical complaints and for self-care advice.

Again, the results of the empirical research revealed the gap between the potencial of ICTs uses in healthcare and the facts that shape these uses. The inverse care law is still working in the transition of healthcare systems to Network Society.