Research into patient feedback websites usage

Rating your doctor or hospital online is not just the preserve of the 'chattering classes', new research suggests. While the research has not yet hit the headlines, it has been circulated on social media and is available to access for free.

Websites that help people leave feedback on their GP practice and other health services, such as NHS Choices, have been available online for several years. These websites aim to help inform people about NHS services so that they have a better choice of doctors and treatments. A new study has looked at who uses these websites, and why.

Researchers interviewed Londoners in public locations across Hammersmith and Fulham. While 74% of people approached agreed to answer questions, only 29 people (15% of the 200 who agreed to take part in the study) were aware of doctor-rating websites, and six people (3%) had used them.

The study has found that people from a non-White British background and those with lower incomes are more likely to use doctor-rating websites. They also found that people who were the same sex as their GP are more likely to want to use doctor-rating websites.

The researchers suggest that people may be using doctor-rating websites not only as an alternative source of information, but also as a 'complementary' form of information alongside a traditional GP appointment. It found that doctor-rating sites were more likely to be used by people who had a friendly relationship with an attentive GP and by people who thought that their GP did not explain things clearly.

Although this was a small study based on a convenience sample of people, it highlights the fact that it is important to consider user demographics when interpreting results from studies of doctor-rating sites, as they may not be representative of all patients.

Where did this come from?

Researchers from the London School of Economics, Imperial College London, the University of Surrey and King's College London carried out the research. It was not funded by a specific grant from a funding agency in the public, commercial or not-for-profit sectors. The study was published in the open access peer-reviewed journal BMJ Open.

What kind of research was this?

This was a cross-sectional study of 200 participants in the London Borough of Hammersmith and Fulham, although as they were interviewed in public places the interviewees were not necessarily residents of the borough. The study aimed to determine how many people know about doctor-rating websites, whether they use these websites, and if they would use these websites in the future. It also aimed to find out which factors could predict whether people would be willing to use doctor-rating websites.

What did the research involve?

The researchers set out to interview people in public locations such as underground stations, high streets and residential areas around the borough. They approached every third man and every third woman who passed them. Of these, 74% of people agreed to complete the questionnaire. Respondents were 39.6 years old on average, and 54.4% were female, 48.8% White British, and 29% were not currently working (students, retired or unemployed).

Researchers asked participants a series of questions covering:

• their awareness of online rating websites
• their use of online rating websites
• how willing they were to use online websites in the future
• the sources of information that they thought were important when making decisions about where to receive healthcare
• if they had made individual contributions to online rating sites
• their doctor-patient relationship
• if they felt that they were able to make choices about healthcare 
• their general internet usage
• sociodemographic factors

What were the basic results?

Awareness of doctor-rating websites was low – only 29 participants (15% of those who agreed to take part in the study) were aware of them, and only six participants (3%) had used them. Patients who were aware of doctor-rating websites were more likely to:

• be young
• be non-White British or White non-British
• be the same gender as their GP
• have a lower income (not always statistically significant)
• consider the reputation of the doctor to be important
• consider hospital statistics important 

As only a few participants were aware of or used doctor-rating websites, the researchers then analysed the intention to use these websites. They found that the interviewees who said they were likely to use doctor-rating websites were similar to those people who had used them before or were aware that they existed, in that they were more likely to:

• be non-White British
• have a lower income
• be the same gender as their GP

People who reported that they were likely to use doctor-rating websites said that they:

• consider clinical performance and doctor reputation to be important, but are less likely to consider familiarity with their doctor as important
• think that hospital statistics are important sources of information, but are less likely to consider GP advice to be an important source of information 
• consider that their doctor listens to them and have a friendly relationship with their GP, but are less likely to think that their GP explains things clearly
• feel that they have control over healthcare decisions
• are satisfied with the level of choice of GP and hospital they attend for outpatient appointments, but are less likely to be satisfied with their choice of treatments

How did the researchers interpret the results?

The researchers say that earlier debate about whether information on the internet threatens trust between doctors and patients "seems a concern which is not supported by our evidence".

They also concluded that: "Online rating websites can play a major role in supporting patients' informed decisions on which healthcare providers to seek advice from, thus potentially fostering patients' choice in healthcare.

"Subjects who seek and provide feedback on doctor-ranking websites, though, are unlikely to be representative of the overall patients' pool. In particular, they tend to over-represent opinions from non-White British, medium-low income patients who are not satisfied with their choice of healthcare treatments and the level of information provided by their GP.

"Accounting for differences in the users' characteristics is important when interpreting results from doctor-rating sites."

Conclusion

Overall, this cross-sectional study found that few people are aware of and actually use doctor-rating websites. The researchers found that people who are more likely to use these websites are people from a non-White British Background and people with lower incomes. They also found that a patient is more likely to say they would use doctor-rating websites if they are the same sex as their GP.

From the results of this research, it seems that people may be using doctor-rating websites as both complementary and subsitute sources of information to their GP.

Although this was a small study, its survey had a reasonable response rate of 75%. However, its small size and convenience sample from a single area of London mean that further studies are needed to confirm whether the results can be generalised to the whole UK population.