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Is There a Digital Divide among Physicians? A Geographic Analysis of Information Technology in Southern California Physician Offices

Affiliations of the authors: Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California (DSB); RCMI Minority Research Center, Charles R. Drew University School of Medicine, Los Angeles, California (DSB, PR); CalOptima, Orange, California (DMD); Department of Geography, California State University, Northridge, California (PR).

Correspondence and reprints: Douglas S. Bell, MD, PhD, UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Room 314, Los Angeles, CA 90095-1736; e-mail: <dbell{at}ucla.edu>.

Received for publication: 01/31/03; accepted for publication: 03/31/03.

Objective: The aim of this study was to determine whether physician offices located in high-minority and low-income neighborhoods have different levels of access to information technology than offices located in lower-minority and higher-income areas.

Design: A cross-sectional survey was conducted of pediatrics, family medicine, and general practice offices in Orange County, California. Survey data were linked with community demographic data from the 2000 Census using a geographical information system.

Results: Of 307 offices surveyed, 141 responded (46%). Offices located in high-minority and high-poverty areas were as likely to respond as other offices. Among responding offices, 94% had a computer, 77% had Web access, 29% had broadband Internet access, and 53% used computerized scheduling and billing systems. Offices located in minority and low-income communities had equivalent access to each technology. Offices in communities with larger proportions of Hispanics were less likely to have practice Web pages, but other uses of the Internet were not associated with practice location. Offices reported high levels of interest in online clinical systems but also high levels of concern about these systems' usability and confidentiality. Offices with Web access and those with practice management systems expressed greater interest in online clinical systems but also greater levels of concern about usability and confidentiality. These attitudes were equivalent among offices in different communities.

Conclusion: Primary care offices located in poor and minority communities in a large, suburban county had high levels of access to and interest in Web-based systems. Physicians' offices may therefore provide a venue for online services aimed at improving health outcomes for poor and minority communities. Research is needed in other geographic regions to determine the generalizability of these findings.