Can the Use of Internet Hospitals Improve physician-patient relationship?: Cross-Sectional Study From Patients’ Perspective in China (Preprint)
Authors: Li Dehe , Hu Yinhuan , Chen Hao , Lu Chuntao , Liu Sha , Yuan Shaochun , Zhang Zemiao 
Published: October 2021

BACKGROUND

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.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.