Kasemsarn P, Boonchai W. Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. PMID: 23414363 [PubMed - as supplied by publisher] 9. BMJ Qual Saf. 2013 Mar;22(3):183-6. doi: 10.1136/bmjqs-2012-001744. Epub 2013 Feb 1.Patient-centred healthcare, social media and the internet: the perfect storm? Rozenblum R, Bates DW. PMID: 23378660 [PubMed - in process] 10. Acta Odontol Scand. 2013 Jan 28. [Epub ahead of print] Patient safety incidents reported by Finnish dentists; results from an internet-based survey. Hiivala N, Mussalo-Rauhamaa H, Murtomaa H. Department of Oral Public Health, Institute of Dentistry, University of Helsinki , Helsinki , Finland. Abstract Background. Few data are available on dental patient safety (PS), as most PS studies have focused on other activities in health care. Objective. To detect types and causes of dental PS incidents (PSIs), including adverse events (AEs) and near misses (NMs), in Finnish dental care. Material and methods. Altogether 1041 privately or publicly employed dentists in southern Finland completed a structured questionnaire using an internet-based system (Webropol) in 2010. Results. Nearly one third of the dentists reported some PSI in the previous 12 months. Of the 872 reported events, 53% were classified as AEs, 45% as NMs and 2% remained unclassified. Nearly half of the PSIs had occurred during some form of dental treatment. One third of the AEs were related to dental equipment, devices and supplies. Most of the reported AEs resulted in little or no permanent harm to patients. However, 13% of AEs were considered as serious enough to potentially cause severe harm or did in fact cause permanent harm. Conclusions. Reported dental PSIs in Finland are in many respects similar to those reported in other countries. Compared to all annual dental visits in Finland, severe dental AEs seem to be relatively rare. Less severe AEs and NMs are not uncommon, especially in dental surgery, endodontic and restorative treatment. The results of this retrospective study, however, reveal more about incident types than their true prevalence and that further studies on dental PS are needed. PMID: 23351166 [PubMed - as supplied by publisher] 11. Trials. 2013 Jan 24;14:25. doi: 10.1186/1745-6215-14-25. Use of the 'patient journey' model in the internet-based pre-fitting counseling of a person with hearing disability: study protocol for a randomized controlled trial. Manchaiah VK, Stephens D, Andersson G, Rönnberg J, Lunner T. Centre for Long Term and Chronic Conditions, College of Human and Health Sciences, Swansea University, Room 167, Glyndwr Building, Swansea SA2 8PP, United Kingdom. [email protected] BACKGROUND: Hearing impairment is one of the most frequent chronic conditions. Persons with a hearing impairment (PHI) have various experiences during their 'journey' through hearing loss. In our previous studies we have developed a 'patient journey' model of PHI and their communication partners (CPs). We suggest this model could be useful in internet-based pre-fitting counseling of a person with hearing disability (PHD). METHODS/DESIGN: A randomized controlled trial (RCT) with waiting list control (WLC) design will be used in this study. One hundred and fifty eight participants with self-reported hearing disability (that is, score > 20 in the Hearing Handicap Questionnaire (HHQ)) will be recruited to participate in this study. They will be assigned to one of two groups (79 participants in each group): (1) Information and counseling provision using the 'patient journey' model; and (2) WLC. They will participate in a 30 day (4 weeks) internet-based counseling program based on the 'patient journey' model. Various outcome measures which focuses on hearing disability, depression and anxiety, readiness to change and acceptance of hearing disability will be administered pre (one week before) and post (one week and six months after) intervention to evaluate the effectiveness of counseling. DISCUSSION: Internet-based counseling is being introduced as a viable option for audiological rehabilitation. We predict that the 'patient journey' model will have several advantages during counseling of a PHD. Such a program, if proven effective, could yield cost and time-efficient ways of managing hearing disability. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System NCT01611129. PMCID: PMC3561257 PMID: 23347711 [PubMed - in process] 12. Contemp Clin Trials. 2013 Mar;34(2):305-11. doi: 10.1016/j.cct.2012.12.002. Epub 2012 Dec 14.
15. Neuropsychiatr Dis Treat. 2012;8:483-9. doi: 10.2147/NDT.S36780. Epub 2012 Oct 23. Outcomes analysis of Internet-based CME initiatives for diagnosis and treatment of fibromyalgia patients: transition from education to physician behavior to patient health. Somasekhar MM, Berney S, Rausch C, Degnan J. The Albert J Finestone Office for Continuing Medical Education, Philadelphia, PA, USA. A well designed outcomes research study was performed in which 20 primary care physicians were selected to participate. Each physician had more than 30 fibromyalgia patients in their practice. The study design consisted of four phases. In phase one, physicians undertook a self-assessment of their practice. Phase two of the study involved diagnosis and treatment of a virtual case vignette. The third phase consisted of analysis of the data from phase two andproviding feedback from an expert rheumatologist, and the fourth phase was to complete patient report forms for five patients in their practice. The year-long study was completed by 12 physicians and resulted in data on 60 patients. The results of this study provide an insight into how physicians are diagnosing and treating patients with fibromyalgia. In this study, we transition from continuing medical education to physician behavior to patient outcomes. PMCID: PMC3484898 PMID: 23118542 [PubMed] 16. J Med Internet Res. 2012 Oct 11;14(5):e137. doi: 10.2196/jmir.2202. Conducting research on the Internet: medical record data integration with patient-reported outcomes. Cascade E, Marr P, Winslow M, Burgess A, Nixon M. Digital Patient Unit, Quintiles, Durham, NC 27707, United States. [email protected] BACKGROUND: The growth in the number of patients seeking health information online has given rise to new direct-to-patient research methods, including direct patient recruitment and study conduct without use of physician sites. While such patient-centric designs offer time and cost efficiencies, the absence of physician-reported data is a key concern, with potential impact on both scientific rigor and operational feasibility. OBJECTIVE: To (1) gain insight into the viability of collecting patient-reported outcomes and medical record information in a sample of gout patients through a direct-to-patient approach (ie, without the involvement of physician sites), and (2) evaluate the validity of patient-reported diagnoses collected during a patient-reported outcomes plus medical record (PRO+MR) direct-to-patient study. METHODS: We invited a random sample of MediGuard.org members aged 18 to 80 years to participate via email based on a gout treatment or diagnosis in their online profiles. Interested members clicked on an email link to access study information, consent to participate electronically, and be screened for eligibility. The first 50 consenting participants completed an online survey and provided electronic and wet signatures on medical record release forms for us to obtain medical charts from their managing physicians. RESULTS: A total of 108 of 1250 MediGuard.org members (8.64%) accessed study information before we closed the study at 50 completed surveys. Of these 108 members who took the screener, 50 (46.3%) completed the study, 19 (17.6%) did not pass the screening, 5 (4.6%) explicitly declined to participate due to the medical record requirement, and 34 (31.5%) closed the browser without completing the survey screener. Ultimately, we obtained 38 of 50 charts (76%): 28 collected using electronic signature and 10 collected based on wet signature on a paper form. Of the 38 charts, 37 cited a gout diagnosis (35 charts) or use of a gout medication (2 charts). Only 1 chart lacked any mention of gout. CONCLUSIONS: Patients can be recruited directly for observational study designs that include patient-reported outcomes and medical record data with over 75% data completeness. Although the validity of self-reported diagnosis is often a concern in Internet-based studies, in this PRO+MR study pilot, nearly all (37 of 38)charts confirmed patient-reported data. PMCID: PMC3510750 PMID: 23060427 [PubMed - indexed for MEDLINE] 17. Open Rheumatol J. 2012;6:190-8. doi: 10.2174/1874312901206010190. Epub 2012 Aug2. Musculoskeletal health professional use of internet resources for personal and patient education: results from an online national survey. Nicolaou M, Armstrong R, Hassell AB, Walker D, Birrell F.
Rheumatology, Northumbria Healthcare NHS Foundation, Ashington, Northumberland, UK. OBJECTIVES: To study the current practice of computer use in musculoskeletal health professionals for their education and that of their patients. METHODS: A survey questionnaire, designed by a working group including representatives from Arthritis Research UK and the British Society for Rheumatology, was made available on surveymonkey.com and the link distributed by email. RESULTS: 190 health professionals responded. Rheumatology professionals made up two thirds of the participants. The modal age group of responders was under 40 years (37%). 97% had spent some educational time on a computer. Females were younger and spent more time using the computer for education purposes. The preferred learning modality was interactive online content (71%). The most common methods of educating patients were the Consultant and Specialist nurse while the web is used by 40% of the health professionals. The most common barrier to education was 'Insufficient resources for education groups'. Rheumatologists were more likely to log Continuous Professional Development (CPD) online, complete online modules and have mandatory training online. UpToDate and Arthritis Research UK were the highest rated websites for health professional and patient education respectively. CONCLUSIONS: This is the first national survey of E-learning in the musculoskeletal health profession, with a large proportion of Rheumatologists. Almost all use computer based learning. Use of the internet for patient education is low. Highly rated educational websites are available for both professionals and patients. PMCID: PMC3415626 PMID: 22970071 [PubMed] 18. Inform Health Soc Care. 2013 Mar;38(2):93-103. doi: 10.3109/17538157.2012.710688. Epub 2012 Sep 7. Integration of computer and Internet-based programmes into psychiatric out-patient care of adolescents with depression. Kurki M, Hätönen H, Koivunen M, Anttila M, Välimäki M. Department of Nursing Science, University of Turku and Primary Health Care Organization of the city of Vantaa, Finland. [email protected] The aim of this explorative study was to describe nurses' opportunities to integrate computer and Internet-based programmes in psychiatric out-patient care among adolescents with depression. Therefore, nurses' daily computer use and possible problems related to it were investigated. The data were collected by conducting focus group interviews with Finnish registered nurses (n =12) working at the out-patient clinics of two university central hospitals. The data were analysed using inductive content analysis. The analysis showed that nurses used the computer and Internet in their daily work for data transmission and informal interaction with adolescents. Findings revealed that nurses have good computer skills, a positive attitude towards using the computer and Internet and were motivated to make use of both on a daily basis. Problems faced in daily computer use were a lack of instructions and education, and lack of help and support. We can conclude that nurses have good opportunities to implement computer and Internet-based programmes in adolescent out-patient care. These results are encouraging keeping in mind that adolescents are the most active Internet users in society. PMID: 22958142 [PubMed - in process]
19. Ann R Coll Surg Engl. 2012 Jul;94(5):300-1. doi: 10.1308/003588412X13171221590250. Evaluation of internet derived patient information. Ward JB, Leach P. Cardiff University, UHW Main Building, Heath Park, Cardiff CF14 4XN, UK. [email protected] INTRODUCTION: The internet is a widely used, powerful resource for patients to research medical conditions. There is an extensive amount of information available on the internet. It is important for patient information to be accurate and in an easily accessible format. This article aims to assess the quality of patient information on hydrocephalus and compares the findings with recent evaluations in other surgical specialties. METHODS: The term 'hydrocephalus' was searched for on the search engines http://www.google.com/, http://www.bing.com/ and http://www.yahoo.com/. The top 20 results of these searches were assessed using the University of Michigan consumer health website evaluation checklist. RESULTS: The quality of patient information websites on hydrocephalus is highly variable. Websites rarely provide sufficient authorship information, do not review their information regularly enough and only reference material occasionally. The background of the provider was found to influence the quality of the website, with academic and care providers creating the best websites. CONCLUSIONS: On comparing our findings with those of recent studies from other surgical specialties, it was found that there was often a conflict of interest between the background of the provider and the information supplied. It is recommended that clinicians personally research material for their patients to be able to guide them to suitable, accurate websites. PMID: 22943222 [PubMed - indexed for MEDLINE] 20. J Plast Surg Hand Surg. 2012 Sep;46(3-4):248-51. doi: 10.3109/2000656X.2012.697376. Role of the internet in communication between patient and surgeon before rhinoplasty. Szychta P, Zieliński T, Rykała J, Witmanowski H, Kruk-Jeromin J. Department of Oncological Surgery and Breast Diseases, Polish Mother's Memorial Hospital - Research Institute, Lodz, Poland. [email protected] Our aim was to assess the use of the internet for patients considering rhinoplasty, to identify the influence of the medical information acquired, and to review favourable and adverse aspects of the acquired knowledge online. A prospective study was conducted on 106 patients listed for post-traumatic or aesthetic rhinoplasty. We surveyed 18 questions to evaluate demographic and sociological data, and the importance of the information acquired from the internet. Respondents searched online for description of operations, contact with other patients, and with the surgeon, and for preoperative and postoperative pictures. Patients who were considering aesthetic rhinoplasty were given medical information by a third party or from the internet, and those who were having post-traumatic corrections were usually referred by their general practitioner. We conclude that the internet is an important source of medical information about rhinoplasty for patients, but it does not contain enough data. It plays an essential part, particularly for those patients having the operation for aesthetic reasons, in contrast to those having post-traumatic correction. Reviewing and certifying the plastic surgical websites would validate certified
services. Independent, direct contact with the doctor helps patients to obtain more accurate, personalized knowledge. In addition, surgeons should support patients by giving them a list of verified websites, which would contribute to increased doctor-patient communication. PMID: 22909242 [PubMed - indexed for MEDLINE] 21. BMC Med Inform Decis Mak. 2012 Aug 6;12:87. doi: 10.1186/1472-6947-12-87. Patient access to complex chronic disease records on the Internet. Bartlett C, Simpson K, Turner AN. Department Health Sciences, University of York, York, YO10 5ZZ, UK. BACKGROUND: Access to medical records on the Internet has been reported to be acceptable and popular with patients, although most published evaluations have been of primary care or office-based practice. We tested the feasibility and acceptability of making unscreened results and data from a complex chronic disease pathway (renal medicine) available to patients over the Internet in a project involving more than half of renal units in the UK. METHODS: Content and presentation of the Renal PatientView (RPV) system was developed with patient groups. It was designed to receive information from multiple local information systems and to require minimal extra work in units. After piloting in 4 centres in 2005 it was made available more widely. Opinions were sought from both patients who enrolled and from those who did not in a paper survey, and from staff in an electronic survey. Anonymous data on enrollment and usage were extracted from the webserver. RESULTS: By mid 2011 over 17,000 patients from 47 of the 75 renal units in the UK had registered. Users had a wide age range (<10 to >90 yrs) but were younger and had more years of education than non-users. They were enthusiastic about the concept, found it easy to use, and 80% felt it gave them a better understanding of their disease. The most common reason for not enrolling was being unaware of the system. A minority of patients had security concerns, and these were reduced after enrolling. Staff responses were also strongly positive. They reported that it aided patient concordance and disease management, and increased the quality of consultations with a neutral effect on consultation length. Neither patient nor staff responses suggested that RPV led to an overall increase in patient anxiety or to an increased burden on renal units beyond the time required to enroll each patient. CONCLUSIONS: Patient Internet access to secondary care records concerning a complex chronic disease is feasible and popular, providing an increased sense of empowerment and understanding, with no serious identified negative consequences. Security concerns were present but rarely prevented participation. These are powerful reasons to make this type of access more widely available. PMCID: PMC3438097 PMID: 22867441 [PubMed - indexed for MEDLINE] 22. Otolaryngol Head Neck Surg. 2012 Nov;147(5):855-7. doi: 10.1177/0194599812456153. Epub 2012 Jul 31. The digital divide in Internet-based patient education materials. Sun GH. University of Michigan, Ann Arbor, MI, USA. [email protected] The ubiquity of the Internet has led to the widespread availability of health-related information to the public, and the subsequent empowerment of
28. BMJ Qual Saf. 2012 Jul;21(7):600-5. doi: 10.1136/bmjqs-2012-000906. Epub 2012 Apr 20. Associations between Internet-based patient ratings and conventional surveys of patient experience in the English NHS: an observational study. Greaves F, Pape UJ, King D, Darzi A, Majeed A, Wachter RM, Millett C. Department of Primary Care and Public Health, Reynolds Building, Charing Cross Campus, Imperial College London, London, UK. [email protected] OBJECTIVE: Unsolicited web-based comments by patients regarding their healthcare are increasing, but controversial. The relationship between such online patient reports and conventional measures of patient experience (obtained via survey) is not known. The authors examined hospital level associations between web-based patient ratings on the National Health Service (NHS) Choices website, introduced in England during 2008, and paper-based survey measures of patient experience. The authors also aimed to compare these two methods of measuring patient experience. DESIGN: The authors performed a cross-sectional observational study of all (n=146) acute general NHS hospital trusts in England using data from 9997 patient web-based ratings posted on the NHS Choices website during 2009/2010. Hospital trust level indicators of patient experience from a paper-based survey (five measures) were compared with web-based patient ratings using Spearman's rank correlation coefficient. The authors compared the strength of associations among clinical outcomes, patient experience survey results and NHS Choices ratings. RESULTS: Web-based ratings of patient experience were associated with ratings derived from a national paper-based patient survey (Spearman �=0.31-0.49, p<0.001 for all). Associations with clinical outcomes were at least as strong for online ratings as for traditional survey measures of patient experience. CONCLUSIONS: Unsolicited web-based patient ratings of their care, though potentially prone to many biases, are correlated with survey measures of patient experience. They may be useful tools for patients when choosing healthcare providers and for clinicians to improve the quality of their services. PMID: 22523318 [PubMed - indexed for MEDLINE] 29. Am J Med Qual. 2012 Nov-Dec;27(6):494-502. doi: 10.1177/1062860611436246. Epub 2012 Apr 18. Consistency of patient preferences about a secure internet-based patient communications portal: contemplating, enrolling, and using. Wakefield DS, Kruse RL, Wakefield BJ, Koopman RJ, Keplinger LE, Canfield SM, Mehr DR. University of Missouri, Columbia, MO, USA. [email protected] Internet-based secure communication portals (portal) have the potential to enhance patient care via improved patient-provider communications. This study examines differences among primary care patients' perceptions when contemplating using, enrolling to use, and using a portal for health care purposes. A total of 3 groups of patients from 1 Midwestern academic medical center were surveyed at different points in time: (1) Waiting Room survey asking about hypothetical interest in using a portal to communicate with their physicians; (2) patient portal Enrollment survey; and (3) Follow-up postenrollment experience survey. Those who enroll and use a patient portal have different demographic characteristics and interest levels in selected portal functions (eg, e-mailing providers, viewing medical records online, making appointments) and initially perceive only limited improvements in care because of the portal. These differences have potential market implications and provide insight into selecting
University of Pittsburgh School of Medicine, Pittsburgh; Drexel University College of Medicine; Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Kimmel Cancer Center, Philadelphia, PA; Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. PURPOSE: A wiki is a collaborative Web site, such as Wikipedia, that can be freely edited. Because of a wiki's lack of formal editorial control, we hypothesized that the content would be less complete and accurate than that of a professional peer-reviewed Web site. In this study, the coverage, accuracy, and readability of cancer information on Wikipedia were compared with those of the patient-orientated National Cancer Institute's Physician Data Query (PDQ) comprehensive cancer database. METHODS: For each of 10 cancer types, medically trained personnel scored PDQ and Wikipedia articles for accuracy and presentation of controversies by using an appraisal form. Reliability was assessed by using interobserver variability and test-retest reproducibility. Readability was calculated from word and sentence length. RESULTS: Evaluators were able to rapidly assess articles (18 minutes/article), with a test-retest reliability of 0.71 and interobserver variability of 0.53. For both Web sites, inaccuracies were rare, less than 2% of information examined. PDQ was significantly more readable than Wikipedia: Flesch-Kincaid grade level 9.6 versus 14.1. There was no difference in depth of coverage between PDQ and Wikipedia (29.9, 34.2, respectively; maximum possible score 72). Controversial aspects of cancer care were relatively poorly discussed in both resources (2.9 and 6.1 for PDQ and Wikipedia, respectively, NS; maximum possible score 18). A planned subanalysis comparing common and uncommon cancers demonstrated no difference. CONCLUSION: Although the wiki resource had similar accuracy and depth as the professionally edited database, it was significantly less readable. Further research is required to assess how this influences patients' understanding and retention. PMCID: PMC3170066 PMID: 22211130 [PubMed - in process] 36. Online J Public Health Inform. 2012;4(1). pii: ojphi.v4i1.3684. doi: 10.5210/ojphi.v4i1.3684. Epub 2012 May 17. Appraisal Skills, Health Literacy and the Patient-Provider Relationship: Considerations as the Health Care Consumer Turns to the Internet to Inform their Care. O'Dell R. A. T. Still University, Arizona, USA. Health care consumers increasingly obtain health information from the Internet to inform their health care; the health care consumer, who also has the role of patient, maintains the right to access information from sources of their choosing for this purpose. However, noteworthy considerations exist including information appraisal skills, health literacy and the patient-provider relationship. Awareness and education are warranted to assist the health care consumer in achieving proficiency as they turn to the Internet for health information. PMCID: PMC3615802 PMID: 23569625 [PubMed] 37. Dis Colon Rectum. 2012 Jan;55(1):85-9. doi: 10.1097/DCR.0b013e3182351eec.
Assessment of the quality of patient-orientated Internet information on surgery for diverticular disease. Yeung TM, Mortensen NJ. Stanford University School of Medicine, Stanford, California, USA. [email protected] BACKGROUND: The Internet is a vast resource available for patients to obtain health information. OBJECTIVE: This study examines the quality of Web sites that provide information on diverticular disease, treatment options, and surgery. DESIGN: Two search engines (Google and Yahoo) and the search terms "surgery and diverticular disease" and "surgery and diverticulitis" were used. The first 50 sites of each search were assessed. Sites that fulfilled the inclusion criteria were evaluated for content and scored by using the DISCERN instrument, which evaluates the quality of health information on treatment choices. RESULTS: Two hundred sites were examined, of which 60 (30%) provided patient-orientated information. 50 sites (25%) were duplicated, 7 (3.5%) were links, 10 (5%) were advertisements, 14 (7%) were resources for clinicians, 9 (4.5%) were message forums, 27 (13.5%) were articles, and 15 (7.5%) were dead links. Of the 60 Web sites that provided patient information, only 10 (16.7%) had been updated within the past 2 years. Seventeen (28.3%) sites were affiliated with hospitals and clinics, but another 17 (28.3%) sites were associated with private companies with commercial interests. Although most Web sites contained information on symptoms, complications, investigations, and treatment options of diverticular disease, 20 (33.3%) did not describe any of the risks of surgery, and 45 (75%) did not provide information on the timescale of recovery postoperatively. Eighteen sites did not provide balanced information on treatment options; of these, 7 were biased toward medical treatment and 6 focused on laparoscopic surgery. Overall, only 22 (36.7%) were identified as being "good" or "excellent" with the use of the DISCERN criteria. CONCLUSIONS: The quality of patient information on surgery for diverticular disease is highly variable, and Web sites that are sponsored by private companies may be biased in discussing treatment options. There is potential for the Internet to provide valuable information, and clinicians should guide patients to access high-quality Web sites. PMID: 22156872 [PubMed - indexed for MEDLINE] 38. J Gen Virol. 2012 Mar;93(Pt 3):526-30. doi: 10.1099/vir.0.037259-0. Epub 2011 Nov 23. A naturally occurring human/hepatitis E recombinant virus predominates in serum but not in faeces of a chronic hepatitis E patient and has a growth advantage in cell culture. Nguyen HT, Torian U, Faulk K, Mather K, Engle RE, Thompson E, Bonkovsky HL, Emerson SU. Molecular Hepatitis Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. Hepatitis E virus is the aetiological agent of acute hepatitis E, a self-limiting disease prevalent in developing countries. Molecular analysis of viral genomic RNA from a chronically infected patient confirmed the recent discovery that chronic infection correlated with extensive diversification of the virus quasispecies: the hypervariable region of some virus genomes in this USA patient contained large continuous deletions and a minor proportion of genomes in faeces and serum had acquired a mammalian sequence that encoded 39 aa of S19 ribosomal
protein fused to the virus non-structural protein. Genomes with this insert were selected during virus passage in cultured cells to become the predominant species, suggesting that the inserted sequence promoted virus growth. The results demonstrated that hepatitis E virus can mutate dramatically during a prolonged infection and suggests it may be important to prevent or cure chronic infections before new variants with unpredictable properties arise. PMCID: PMC3352352 PMID: 22113007 [PubMed - indexed for MEDLINE] 39. Hum Reprod Update. 2012 Mar-Apr;18(2):211-27. doi: 10.1093/humupd/dmr045. Epub 2011 Nov 22. Patient-focused internet interventions in reproductive medicine: a scoping review. Aarts JW, van den Haak P, Nelen WL, Tuil WS, Faber MJ, Kremer JA. Department of Obstetrics and Gynaecology, Radboud University Nijmegen Medical Centre, 6500 HB Nijmegen, The Netherlands. BACKGROUND: The Internet has revolutionized fertility care since it became a popular source of information and support for infertile patients in the last decade. The aim of this scoping review is to map (i) the main categories of patient-focused Internet interventions within fertility care, (ii) the detailed composition of the interventions and (iii) how these interventions were evaluated. METHODS: A literature search used various 'Internet' and 'Infertility' search terms to identify relevant studies published up to 1 September 2011. The selected studies had to include patients facing infertility and using an infertility-related Internet intervention. We charted data regarding categories of interventions, components of interventions and evaluation methodology. We categorized the stages of research using the UK's Medical Research Council framework for evaluating complex interventions. RESULTS: We included 20 studies and identified 3 educational interventions, 2 self-help interventions, 1 human-supported therapeutic intervention, 9 online support groups and 2 counselling services. Information provision, support and mental health promotion were common aims. Few interactive online components were present in the online programmes. Three studies were in the pilot phase and 17 were in the evaluation phase. CONCLUSIONS: Several categories of patient-focused Internet-based interventions in fertility care are primarily applied to provide support and education and promote mental health. The interventions could be improved by using more interactive and dynamic elements as their key components. Finally, more emphasis on methodological standards for complex interventions is needed to produce more rigorous evaluations. This review shows where further development or research into patient-focused Internet interventions in fertility-care practice may be warranted. PMID: 22108381 [PubMed - in process] 40. HDA Now. 2011 Summer:11. Patient reviews on the Internet. Lombardi G. Officite, USA. PMID: 22096840 [PubMed - indexed for MEDLINE]
Internet and e-mail use in ENT: a survey of patient usage and satisfaction. Shaw B, Farboud A, Trinidade A, Kothari P. University College London, Gower Street, London, WC1E 6BT, UK. Nowadays, internet and e-mail are important modes of communication and information. This paper seeks to determine internet usage as a source of health information amongst ENT patients and to investigate whether patients prefer to communicate primarily with the hospital via e-mail. The method used is a questionnaire study and 201 patients attending an ENT clinic completed questionnaires over 2 weeks in December 2010. Of those with internet access (85%), 37% had used it for health information prior to their appointment; 90% rated the information between average and excellent; over half stated they would like doctor-recommended websites. Overall, 8% had previously used e-mail to communicate with healthcare professionals, but 50% stated that they wished to use e-mail in the future. ENT patients are becoming increasingly computer-literate. As healthcare professionals, we must do more to incorporate the internet as a source of reliable healthcare information. Properly implemented, e-mail can become an invaluable method of communication with patients. PMID: 21968629 [PubMed - indexed for MEDLINE] 44. Can J Surg. 2011 Oct;54(5):339-43. doi: 10.1503/cjs.011910. Information on the Internet about colorectal cancer: patient attitude and potential toward Web browsing. A prospective observational study. Sajid MS, Shakir AJ, Baig MK. Department of Colorectal Surgery, Worthing Hospital, Worthing. West Sussex, United Kingdom. [email protected] BACKGROUND: Patients with colorectal cancer who seek to improve their knowledge of health and treatment options can now access in a few seconds data that would previously have required hours of research. Our aim was to evaluate the attitudes of patients toward Web browsing for information on colorectal cancer. METHODS: We surveyed all patients attending a colorectal cancer follow-up clinic between January and August 2007 on their use of the Internet to obtain information on colorectal cancer. RESULTS: In all, 439 patients with mean age of 68.6 years participated in the study. Of these, 24% reported using the Internet to obtain colorectal cancer information. Most participants used the Google search engine. Only 13% of participants confirmed that colorectal cancer information on the Internet was helpful in decision-making. Patients under the age of 65 years were more likely to have Internet access (p < 0.001), more likely to use the Internet to find colorectal cancer information (p = 0.005) and more likely to access a site recommended by a colorectal specialist (p = 0.002). Among Internet users, men were slightly more likely than women to use the Internet, although the difference was not significant (p = 0.20). CONCLUSION: The Internet is a useful tool for disseminating information about colorectal cancer. The best sites are still difficult for patients to distinguish from the thousands of sites returned by search engines. This study demonstrates that the level of potential interest is sufficient to justify the development of a departmental or regional colorectal cancer network of websites and indicates areas of interest for patients. PMCID: PMC3195665 PMID: 21933528 [PubMed - indexed for MEDLINE]
45. Healthc Q. 2011;14(2):101-5. Patient relations office facilitate community engagement: using Internet-based correspondence to encourage discussion at the University Health Network. Rogers S, Sedge E. University Health Network, in Toronto, Ontario, Canada. PMID: 21841402 [PubMed - indexed for MEDLINE] 46. Int J Qual Stud Health Well-being. 2011;6(3). doi: 10.3402/qhw.v6i3.5907. Epub 2011 Jul 12. Support through patient internet-communities: Lived experience of Russian in vitro fertilization patients. Isupova OG. Institute of Demography High School of Economics, Moscow, Russian Federation. The article is concerned with the life experiences of infertile women going through infertility treatment and their need for social and psychological support, which they try to find in their immediate social environment. The Internet has become one place where everyone can find "people like oneself." The best support is received from these people who are in the same life situation and are able and willing to share their lived experiences with each other. Communication via the Internet and the formation of a virtual community of patients has both positive and negative aspects, all of which are examined in the article. On the one hand, it creates a psychologically favorable atmosphere and might potentially increase the success rate of IVF treatment. On the other, this leads to the seclusion of patients within the circle of "similar people" and sometimes to negative attitudes towards people outside the circle. The article is based on the author's "netnography" research of a virtual community of Russian In-Vitro Fertilization (IVF)(1) patients. PMCID: PMC3136244 PMID: 21760835 [PubMed] 47. Comput Inform Nurs. 2011 Dec;29(12):714-8; quiz 719-20. doi: 10.1097/NCN.0b013e318224b597. Patient-provider internet portals--patient outcomes and use. Shaw RJ, Ferranti J. Duke University School of Nursing, Durham, NC 27710, USA. [email protected] An important emerging information technology tool is the electronic health record with a patient-provider Internet portal. Patient-provider Internet portals offer a venue for providing patient access to personal health data. In this study, we conducted a cross-sectional secondary data analysis to describe the types of diabetes patients who utilize the patient-provider Internet portal and examine any preliminary differences in patient outcomes. Data from this study suggest that a significant portion of patients (29.7%) with diabetes utilize the portal. Clinical outcome results indicated that portal use was not a significant predictor of low-density lipoprotein and total cholesterol levels. However, portal use was a statistically significant predictor of glycosylated hemoglobin (HbA1c) (P < .001). As patient-provider Internet portals are increasingly
their relationship with their doctor. METHODS: A cross-sectional survey was conducted among a convenience sample of patients visiting 10 primary care clinics in central Israel using a questionnaire developed for this survey. The survey examined attitudes to using the internet for health-related information and attitudes to sharing this information with doctors. Associations between demographic variables, internet use and patient satisfaction with the doctor's response were tested using the chi-square statistic and t-tests. RESULTS: Completed questionnaires were received from 138 patients; the response rate was 69%. Patients in the study sample had a high rate of internet access (87%), with many using the internet as a source of health information (41%) although most patients using the internet never share this information with their doctor (81%). Among those who share information with the doctor, most felt that this has a positive effect on the relationship (870/%). Few patients reported being referred to websites by the doctor (28%). CONCLUSIONS: Internet use is prevalent in this population, though physicians may be unaware of this. Future study could examine the effects of doctors who ask patients actively about their internet use and inform them of relevant health information sources online. PMID: 21598810 [PubMed - indexed for MEDLINE] 51. Lakartidningen. 2011 Mar 30-Apr 5;108(13):727-9. [Social media change the professional-patient relation. Clarification of ethical guidelines concerning social networking on the Internet is necessary]. [Article in Swedish] Chenik M, Bolinder G, Juth N. Karolinska universitetssjukhuset, Stockholm. [email protected] PMID: 21574413 [PubMed - indexed for MEDLINE] 52. Arch Pediatr Adolesc Med. 2011 May;165(5):405-11. doi: 10.1001/archpediatrics.2011.55. Variation in use of Internet-based patient portals by parents of children with chronic disease. Byczkowski TL, Munafo JK, Britto MT. Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA. [email protected] OBJECTIVES: To assess the use of Internet-based portals among families of children with chronic diseases and to describe characteristics of portal registrants and users. DESIGN: Retrospective observational study. SETTING: Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, using data from September 1, 2003, through February 29, 2008. Patients/ PARTICIPANTS: Parents of children with diabetes mellitus, juvenile idiopathic arthritis, or cystic fibrosis. INTERVENTIONS: Parents of children with a chronic disease were given the opportunity to access health-related information for their children via an Internet-based portal. OUTCOME MEASURES: Percentage of families who obtained a portal account (registered), used the portal for the first time within 3 months and again 3 to 6
months after registration, number of times logged in, and session length. RESULTS: Of 1900 families, 27.9% obtained a portal account. Of those, 47.8% used the portal within 3 months of registration and 15.9% continued to use the portal 3 to 6 months after registration. Families of African American patients and of patients insured by Medicaid were less likely to obtain a portal account. More outpatient visits and having private health insurance coverage were associated with increased portal registration and use. CONCLUSIONS: Understanding the feasibility of portal use by parents is an important first step to using portals for improving self-management, patient-provider interactions, and outcomes for children with chronic diseases. Subsequent studies should address parent perceptions of the value portals add to the management of the chronic disease of their child and ways to increase that value. Barriers to using portals among racial minorities and publicly insured families should also be studied to address disparities. PMID: 21536954 [PubMed - indexed for MEDLINE] 53. Sultan Qaboos Univ Med J. 2010 Aug;10(2):169-79. Epub 2010 Jul 19. "I Found it on the Internet": Preparing for the e-patient in Oman. Masters K, Ng'ambi D, Todd G. ITHealthEd, Austria. In the Information Age, the communication patterns between doctor and patient are changing. Using Everett Rogers' theory of Diffusion of Innovations, this paper begins by examining the diffusion of the Internet in the world and in Oman. It then considers the emergence of e-patients. The characteristics of e-patients are described in some detail. The paper ends by describing steps that should be taken when teaching medical students in Oman so that they can be prepared for e-patients. PMCID: PMC3074705 PMID: 21509226 [PubMed] 54. Sultan Qaboos Univ Med J. 2011 Feb;11(1):129-31. Epub 2011 Feb 12. Re: I found it on the Internet": Preparing for the e-patient in Oman. Alwahaibi N. Department of Pathology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman. PMCID: PMC3074694 PMID: 21509223 [PubMed] 55. J Sex Med. 2011 Jul;8(7):2038-47. doi: 10.1111/j.1743-6109.2011.02263.x. Epub 2011 Apr 7. The ability of the general male public to assess their suitability to take 50-mg sildenafil: an assessment of the comprehension of patient information materials via internet survey. Symonds T, Coyne KS, Margolis MK, Schnetzler G. Pfizer Ltd., Sandwich, Kent, UK United BioSource Corporation, Bethesda, MD, USA. [email protected]
PMID: 21402299 [PubMed - indexed for MEDLINE] 59. Cogn Behav Ther. 2011;40(1):57-64. doi: 10.1080/16506073.2010.529457. Can the patient decide which modules to endorse? An open trial of tailored internet treatment of anxiety disorders. Andersson G, Estling F, Jakobsson E, Cuijpers P, Carlbring P. Department of Behavioural Sciences and Learning, Swedish Institute for Disability Research, Linkoping University, Sweden. [email protected] Internet-delivered cognitive behaviour therapy commonly consists of disorder-specific modules that are based on face-to-face manuals. A recent development in the field is to tailor the treatment according to patient profile, which has the potential to cover comorbid conditions in association with anxiety and mood disorders. However, it could be that the patients themselves are able to decide what modules to use. The authors tested this in an open pilot trial with 27 patients with mixed anxiety disorders. Modules were introduced with a brief description, and patients could choose which modules to use. The exception was the two first modules and the last, which involved psychoeducation and relapse prevention. The treatment period lasted for 10 weeks. Results showed large within-group effect sizes, with an average Cohen's d of 0.88. In a structured clinical interview, a majority (54%) had significantly improved 10 weeks after commencing treatment. Only one person dropped out. On the basis of results of this preliminary study, the authors suggest that the role of choice and tailoring should be further explored in controlled trials and that patient choice could be incorporated into Internet-delivered treatment packages. PMID: 21337215 [PubMed - indexed for MEDLINE] 60. Ugeskr Laeger. 2011 Feb 21;173(8):572-7. [The Internet influences the patient-physician relationship]. [Article in Danish] Riiskjær E, Ammentorp J, Nielsen JF, Kofoed PE. Institut for Økonomi, Aarhus Universitet, Universitetsparken, Bygning 1322, Aarhus C, Denmark. [email protected] So far, we have only limited knowledge on how the patients' use of the Internet affects consultations. A review of 36 empirically based articles from 1999 to 2009 demonstrates that patients' Internet search for health information is widespread. However, there are signs that the impact of Internet searches on consultations is limited as a number of factors reduce the probability of an effect on the dialogue between physician and patient. Results are discussed with reference to three classic consultation models: the paternalistic, the partnership and the consumer model. PMID: 21333257 [PubMed - indexed for MEDLINE] 61. J Am Med Inform Assoc. 2011 May 1;18(3):318-21. doi: 10.1136/jamia.2010.006015. Epub 2011 Jan 24. Social disparities in internet patient portal use in diabetes: evidence that the digital divide extends beyond access.
Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, López A, Schillinger D. Center for Vulnerable Populations at San Francisco General Hospital, University of California San Francisco, San Francisco, California, USA. [email protected] The authors investigated use of the internet-based patient portal, kp.org, among a well-characterized population of adults with diabetes in Northern California. Among 14,102 diverse patients, 5671 (40%) requested a password for the patient portal. Of these, 4311 (76%) activated their accounts, and 3922 (69%), logged on to the patient portal one or more times; 2990 (53%) participants viewed laboratory results, 2132 (38%) requested medication refills, 2093 (37%) sent email messages, and 835 (15%) made medical appointments. After adjustment for age, gender, race/ethnicity, immigration status, educational attainment, and employment status, compared to non-Hispanic Caucasians, African-Americans and Latinos had higher odds of never logging on (OR 2.6 (2.3 to 2.9); OR 2.3 (1.9 to 2.6)), as did those without an educational degree (OR compared to college graduates, 2.3 (1.9 to 2.7)). Those most at risk for poor diabetes outcomes may fall further behind as health systems increasingly rely on the internet and limit current modes of access and communication. PMCID: PMC3078675 PMID: 21262921 [PubMed - indexed for MEDLINE] 62. Ann Oncol. 2011 Feb;22(2):490-1. doi: 10.1093/annonc/mdq746. Epub 2011 Jan 19. Internet to boost patient accrual in oncology trials? A multiinstitutional AERIO study. Rodrigues MJ, Haberer S, Dionysopoulos D, Barrière J, Wassermann J, Tazi Y, Rajpar S, Giroux J, Bidard FC, Loriot Y; AERIO Group. PMID: 21248065 [PubMed - indexed for MEDLINE] 63. Patient Prefer Adherence. 2010 Nov 3;4:397-406. doi: 10.2147/PPA.S14477. Multinational Internet-based survey of patient preference for newer oral or injectable Type 2 diabetes medication. Dibonaventura MD, Wagner JS, Girman CJ, Brodovicz K, Zhang Q, Qiu Y, Pentakota SR, Radican L. Health Sciences Practice, Kantar Health, New York; BACKGROUND: The prevalence of Type 2 diabetes mellitus continues to rise. Although glucagon-like peptide-1 (GLP-1) analog and dipeptidyl peptidase-4 (DPP-4) inhibitor medications are effective, there are differences between these products, including method of administration (injectable versus oral). The objective of this study was to examine patient preferences (and predictors of preferences) for two different medication profiles, one similar to a GLP-1 analog (liraglutide) and another similar to a DPP-4 inhibitor (sitagliptin). METHODS: Internet survey data were collected in two waves (wave 1, n = 2402; wave 2, n = 1340) using patients from the US and Europe. Patients were presented with two hypothetical medication profiles ("drug A" and "drug B", resembling sitagliptin and liraglutide, respectively) and asked to report their preferences. RESULTS: Most patients in wave 1 and wave 2 reported that overall they would prefer a drug with the sitagliptin-like profile (81.9% and 84.4%, respectively) over a drug with the liraglutide-like profile (18.1% and 15.6%, respectively), and >80% of patients reported that they would be able to take a drug with the sitagliptin-like profile as directed by their physician for a longer period. The
likelihood of preferring the sitagliptin-like profile significantly increased as age (odds ratio [OR] = 1.02) and importance placed on method of administration (OR = 1.32) increased (P < 0.05). Although the sitagliptin-like profile was preferred by the majority of patients in all subgroups, a lower proportion of patients with obesity, with weight gain, with A1C values above target, and who exercised preferred the sitagliptin-like profile compared with those without obesity (77.0% versus 87.9%), without weight gain (77.8% versus 86.7%), with A1C values at or below target (79.0% versus 86.5%), and who did not exercise (81.6% versus 86.4%), respectively (P < 0.05). CONCLUSIONS: This research suggests that patients (across geographies) prefer an oral medication with a profile resembling sitagliptin to an injectable medication with a profile resembling liraglutide. PMCID: PMC3003606 PMID: 21206515 [PubMed] 64. J Health Commun. 2010;15 Suppl 3:186-99. doi: 10.1080/10810730.2010.522691. The role of provider-patient communication and trust in online sources in Internet use for health-related activities. Hou J, Shim M. Grady College of Journalism & Mass Communication, University of Georgia, 120 Hooper Street, Athens, GA 30602-3018, USA. [email protected] Provider-patient communication is an important factor influencing patients' satisfaction and health outcomes. This study draws upon the uses and gratification theory to examine how individuals' perception of communication with healthcare providers is associated with their Internet use for health-related activities. Using the data from the 2007 Health Information National Trends Survey (HINTS), we found that as individuals perceived their communication with providers to be less patient-centered, they were more likely to engage in various types of online health activities, such as using websites for healthy lifestyles, searching for healthcare providers, and seeking health information. Trust in online health information was also found to be a significant predictor of online health activities. The results of this study emphasized the important role of provider-patient communication in motivating individuals to turn to the Internet for health purposes. PMID: 21154093 [PubMed - indexed for MEDLINE] 65. Implement Sci. 2010 Nov 17;5:87. doi: 10.1186/1748-5908-5-87. The QUIT-PRIMO provider-patient Internet-delivered smoking cessation referral intervention: a cluster-randomized comparative effectiveness trial: study protocol. Houston TK, Sadasivam RS, Ford DE, Richman J, Ray MN, Allison JJ. Division of Health Informatics and Implementation Science, Quantitative Health Sciences and Medicine, University of Massachusetts Medical School, Worcester, MA, USA. [email protected]. BACKGROUND: Although screening for tobacco use is increasing with electronic health records and standard protocols, other tobacco-control activities, such as referral of patients to cessation resources, is quite low. In the QUIT-PRIMO study, an online referral portal will allow providers to enter smokers' email addresses into the system. Upon returning home, the smokers will receive automated emails providing education about tobacco cessation and encouragement to
use the patient smoking cessation website (with interactive tools, educational resources, motivational email messages, secure messaging with a tobacco treatment specialist, and online support group). METHODS: The informatics system will be evaluated in a comparative effectiveness trial of 160 community-based primary care practices, cluster-randomized at the practice level. In the QUIT-PRIMO intervention, patients will be provided a paper information-prescription referral and then "e-referred" to the system. In the comparison group, patients will receive only the paper-based information-prescription referral with the website address. Once patients go to the website, they are subsequently randomized within practices to either a standard patient smoking cessation website or an augmented version with access to a tobacco treatment specialist online, motivational emails, and an online support group. We will compare intervention and control practice participation (referral rates) and patient participation (proportion referred who go to the website). We will then compare the effectiveness of the standard and augmented patient websites. DISCUSSION: Our goal is to evaluate an integrated informatics solution to increase access to web-delivered smoking cessation support. We will analyze the impact of this integrated system in terms of process (provider e-referral and patient login) and patient outcomes (six-month smoking cessation). TRIAL REGISTRATION: Web-delivered Provider Intervention for Tobacco Control (QUIT-PRIMO) - a randomized controlled trial: NCT00797628. PMCID: PMC2998448 PMID: 21080972 [PubMed] 66. Psychosomatics. 2010 Nov-Dec;51(6):453-7. doi: 10.1176/appi.psy.51.6.453. Morgellons disease, or antipsychotic-responsive delusional parasitosis, in an HIV patient: beliefs in the age of the Internet. Freudenreich O, Kontos N, Tranulis C, Cather C. correspondence and M.D., MGH Schizophrenia Program, Freedom Trail Clinic, 25 Staniford St., 2nd Floor, Boston, MA 02114, USA. [email protected] PMID: 21051675 [PubMed - indexed for MEDLINE] 67. J Health Commun. 2010;15 Suppl 2:183-96. doi: 10.1080/10810730.2010.499988. The literacy divide: health literacy and the use of an internet-based patient portal in an integrated health system-results from the diabetes study of northern California (DISTANCE). Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, Lopez A, Schillinger D. UCSF Center for Vulnerable Populations, Department of Medicine, UCSF Division of General Internal Medicine, San Francisco General Hospital, San Francisco, California 94143-1364, USA. [email protected] Internet-based patient portals are intended to improve access and quality, and will play an increasingly important role in health care, especially for diabetes and other chronic diseases. Diabetes patients with limited health literacy have worse health outcomes, and limited health literacy may be a barrier to effectively utilizing internet-based health access services. We investigated use of an internet-based patient portal among a well characterized population of adults with diabetes. We estimated health literacy using three validated self-report items. We explored the independent association between health literacy and use of the internet-based patient portal, adjusted for age, gender, race/ethnicity, educational attainment, and income. Among 14,102 participants
(28% non-Hispanic White, 14% Latino, 21% African-American, 9% Asian, 12% Filipino, and 17% multiracial or other ethnicity), 6099 (62%) reported some limitation in health literacy, and 5671 (40%) respondents completed registration for the patient portal registration. In adjusted analyses, those with limited health literacy had higher odds of never signing on to the patient portal (OR 1.7, 1.4 to 1.9) compared with those who did not report any health literacy limitation. Even among those with internet access, the relationship between health literacy and patient portal use persisted (OR 1.4, 95% CI 1.2 to 1.8). Diabetes patients reporting limited health literacy were less likely to both access and navigate an internet-based patient portal than those with adequate health literacy. Although the internet has potential to greatly expand the capacity and reach of health care systems, current use patterns suggest that, in the absence of participatory design efforts involving those with limited health literacy, those most at risk for poor diabetes health outcomes will fall further behind if health systems increasingly rely on internet-based services. PMCID: PMC3014858 PMID: 20845203 [PubMed - indexed for MEDLINE] 68. J Med Internet Res. 2010 Aug 19;12(3):e35. doi: 10.2196/jmir.1214. Feasibility of internet-based health-related quality of life data collection in a large patient cohort. Bhinder S, Chowdhury N, Granton J, Krahn M, Tullis DE, Waddell TK, Singer LG. Faculty of Medicine, University of Toronto, Toronto, Canada. BACKGROUND: Patient registries are commonly used to track survival and medical outcomes in large cohorts. However, large-scale collection of health-related quality of life (HRQOL) data is more challenging because such data must be collected directly from patients. Internet-based HRQOL questionnaires are a potential solution, allowing home data collection with immediate storage in a central database. OBJECTIVES: Our objectives were to investigate the sociodemographic predictors of Internet use and willingness to convey HRQOL information over the Internet in a Canadian tertiary care patient population and to determine whether Internet use patterns of tertiary care patients differ from those of the general Canadian population. Additionally, we sought to identify the success of home completion of Internet-based HRQOL questionnaires, as well as factors hindering home completion. METHODS: We surveyed 644 patients at the Toronto General and St. Michael's Hospitals from November 2003 through July 2006 within a prospective, longitudinal cohort study of HRQOL in patients with lung disease or lung transplants. Using multiple logistic regression, we assessed patient age, gender, rurality, marital status, and employment or education status as potential sociodemographic predictors of having an Internet-accessible home computer, using email at least weekly, and willingness to complete a quality of life questionnaire over the Internet. Patients electing to complete questionnaires over the Internet were followed from September 2005 through March 2008 to assess completion of HRQOL questionnaires from home, identify barriers for noncompletion, and determine sociodemographic predictors for home completion. RESULTS: Of the 644 patients, the median age was 51 years, with a similar number of males and females. Most were urban Ontario residents, were unemployed, and were married or in a common-law relationship. Having an Internet-accessible home computer was reported by 79.7% (513/644) of patients and use of email at least weekly by 66.5% (414/623) of patients. A majority of patients (57.1% 368/644) were willing to complete HRQOL questionnaires over the Internet via an emailed link. Of the participating 644 patients, 368 elected to complete future questionnaires from home and, as part of a gradual roll-out of the home HRQOL questionnaire, 211 were sent emails inviting them to do so. Of the invited
patients, 78% (165/211) completed at least one questionnaire from home. The most common reason for noncompletion was a lack of or an inability to find time to complete the questionnaire. No statistically significant sociodemographic predictors of Internet use were associated with completion or noncompletion of questionnaires from home. CONCLUSIONS: Home, Internet-based HRQOL assessment is feasible in tertiary care patient populations with a high predicted rate of Internet usage based on sociodemographic parameters. A large minority of patients were unwilling or unable to take part in home HRQOL assessments indicating that alternative methods of data collection are still required. However, the majority of patients electing to complete home HRQOL assessments went on to do so over the Internet. PMCID: PMC2956333 PMID: 20719740 [PubMed - indexed for MEDLINE] 69. Ann Oncol. 2011 Mar;22(3):723-9. doi: 10.1093/annonc/mdq417. Epub 2010 Aug 17. Evaluation of the SCA instrument for measuring patient satisfaction with cancer care administered via paper or via the Internet. Kamo N, Dandapani SV, Miksad RA, Houlihan MJ, Kaplan I, Regan M, Greenfield TK, Sanda MG. Harvard Medical School, Boston, MA, USA. BACKGROUND: Patients' perspectives provide valuable information on quality of care. This study evaluates the feasibility and validity of Internet administration of Service Satisfaction Scale for Cancer Care (SCA) to assess patient satisfaction with outcome, practitioner manner/skill, information, and waiting/access. PATIENTS AND METHODS: Primary data collected from November 2007 to April 2008. Patients receiving cancer care within 1 year were recruited from oncology, surgery, and radiation clinics at a tertiary care hospital. An Internet-based version of the 16-item SCA was developed. Participants were randomised to Internet SCA followed by paper SCA 2 weeks later or vice versa. Seven-point Likert scale responses were converted to a 0-100 scale (minimum-maximum satisfaction). Response distribution, Cronbach's alpha, and test-retest correlations were calculated. RESULTS: Among 122 consenting participants, 78 responded to initial SCA. Mean satisfaction scores for paper/Internet were 91/90 (outcome), 95/94 (practitioner manner/skill), 89/90 (information), and 86/86 (waiting/access). Response rate and item missingness were similar for Internet and paper. Except for practitioner manner/skill, test-retest correlations were robust r = 0.77 (outcome), 0.74 (information), and 0.75 (waiting/access) (all P < 0.001). CONCLUSIONS: Internet SCA administration is a feasible and a valid measurement of cancer care satisfaction for a wide range of cancer diagnoses, treatment modalities, and clinic settings. PMCID: PMC3042922 PMID: 20716625 [PubMed - indexed for MEDLINE] 70. J Clin Epidemiol. 2010 Nov;63(11):1169-78. doi: 10.1016/j.jclinepi.2009.11.021. Epub 2010 Aug 5. Representativeness of the Patient-Reported Outcomes Measurement Information System Internet panel. Liu H, Cella D, Gershon R, Shen J, Morales LS, Riley W, Hays RD. UCLA Department of Medicine, Division of General Internal Medicine & Health
PMID: 20586847 [PubMed - indexed for MEDLINE] 72. Telemed J E Health. 2010 Jun;16(5):639-41. doi: 10.1089/tmj.2009.0137. Planning for Internet connectivity in remote patient monitoring. Pappas G. Intel Corporation-Digital Health, Beaverton, Oregon 97006, USA. [email protected] It is important for healthcare organizations to understand the requirements and challenges of logistics when deploying remote patient monitoring (RPM) technologies in patient homes. Although most organizations prepare thoroughly for the clinical and work flow aspect of RPM solutions, they neglect to consider the logistical resources necessary to successfully manage a broad deployment. The term "logistics" in this context refers to the processes and infrastructure required to enable the use of RPM technologies in the patient's home. This article has been generated from the findings and observations of several studies where logistical objectives were included in the protocol in addition to the conventional metrics of clinical outcome, satisfaction, and economic measures. These studies implemented several high-speed Internet connectivity models with the use of wired broadband, 3G wireless, or a combination. The organizations that utilized 3G to provide Internet connectivity experienced significantly fewer logistical issues and patient frustration. It was also observed that regardless of the model, each of the clinical partners in these studies were not adequately prepared to manage Internet connectivity. Because of this, all experienced some level of difficulty installing and supporting RPM devices in the home. PMID: 20575734 [PubMed - indexed for MEDLINE] 73. Telemed J E Health. 2010 Jul-Aug;16(6):664-9. doi: 10.1089/tmj.2010.0003. The role of the internet on patient knowledge management, education, and decision-making. Ilic D. Monash Institute of Health Services Research, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. [email protected] E-health encompasses a broad range of health disciplines that use the Internet and associated technologies to deliver information and health services. Traditionally, patients have relied on the healthcare professional to provide relevant medical information to inform decision making on diagnosis and therapy. Patient education in the past has consisted of independently collated health information, disseminated predominantly in written and video formats. Greater accessibility to the Internet has provides a novel method for patients to access health information and play a greater role in decisions ultimately affecting their health. However, patients' ability to access, understand, and integrate this knowledge with their healthcare professional influences the extent to which such technologies are effective. This article provides an overview of the impact of the Internet on patient knowledge management, education, and its subsequent impact upon the medical decision-making process between the patient and clinician. PMID: 20575610 [PubMed - indexed for MEDLINE]
74. Clin Orthop Relat Res. 2010 Oct;468(10):2566-71. doi: 10.1007/s11999-010-1440-3. The internet and the physician-patient relationship. Sechrest RC. Medical Multimedia Group, LLC, 2300 Regent Street, Suite 205, Missoula, MT 59801, USA. [email protected] BACKGROUND: Since the emergence of the public Internet in the early 1990s, the healthcare industry has been struggling to understand how best to utilize this resource. During the last decade there has been an increase in both the interest and participation by healthcare providers in the Internet space, but many observers continue to push for more development of healthcare resources to better support the provider-patient relationship. QUESTIONS/PURPOSES: This paper will review the historical development of the Internet, the core concepts that have driven the emergence and evolution of the Internet as a mass medium of information exchange, and how the healthcare industry can harness the Internet to improve the provider patient relationship. WHERE ARE WE NOW?: The healthcare industry continues to lag behind other industries that have been transformed by the Internet. Numerous industries including travel, real estate, retail sales, and banking have migrated both comprehensive information resources and transactions to the Internet in order to improve efficiency and customer satisfaction. That same process is occurring now in the healthcare industry. Credible and comprehensive Information resources are beginning to mature. Transactions are still in their infancy, reflecting a continued concern about privacy and security. WHERE DO WE NEED TO GO?: We need to improve information resources to educate and inform patients. Improving the availability and credibility of information resources will empower patients to make better healthcare decisions and I contend will ultimately reduce the cost of delivering care. HOW DO WE GET THERE?: Orthopaedists must first recognize the value of information resources to the patient. Effective communication with patients is a critical component of providing healthcare services. All healthcare providers should reflect on the importance of developing an effective communications strategy for their own practice and consider the benefits of participating in efforts by professional organizations to improve existing information resources. PMCID: PMC3049632 PMID: 20574803 [PubMed - indexed for MEDLINE] 75. J Am Geriatr Soc. 2010 Jun;58(6):1148-52. doi: 10.1111/j.1532-5415.2010.02864.x. Epub 2010 May 7. An internet-based communication network for information transfer during patient transitions from skilled nursing facility to the emergency department. Hustey FM, Palmer RM. Emergency Services Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA. [email protected] OBJECTIVES: To determine whether the implementation of an Internet-based communication system improves the amount of essential information conveyed between a skilled nursing facility (SNF) and the emergency department (ED) during patient care transitions. DESIGN: Interventional; before and after. SETTING: ED of an urban teaching hospital with approximately 55,000 visits per year and a 55-bed subacute free-standing rehabilitation facility (the SNF). PARTICIPANTS: All patients transferred from the SNF to the ED over 16 months. INTERVENTION: An Internet-based communication network with SNF-ED transfer form for communication during patient care transitions.
MEASUREMENTS: Nine elements of patient information assessed before and after intervention through chart review. Secondary outcomes: changes in efficiency of information transfer and staff satisfaction. RESULTS: Two hundred thirty-four of 237 preintervention and all 276 postintervention care transitions were reviewed. The Internet communication network was used in 78 (26%) of all care transitions, peaking at 40% by the end of the study. There was more critical patient information (1.85 vs 4.29 of 9 elements; P<.001) contained within fewer pages of transfer documents (24.47 vs 5.15; P<.001) after the intervention. Staff satisfaction with communication was higher among ED physicians after the intervention. CONCLUSION: The use of an Internet-based system increased the amount of information communicated during SNF-ED care transitions and significantly reduced the number of pages in which this information was contained. PMID: 20487072 [PubMed - indexed for MEDLINE] 76. J Psychosoc Oncol. 2010 Mar;28(2):127-42. doi: 10.1080/07347330903570495. Doctor-patient communication about cancer-related internet information. Bylund CL, Gueguen JA, D'Agostino TA, Li Y, Sonet E. Memorial Sloan-Kettering Cancer Center, New York, NY, USA. This article explores the effect of doctor-patient communication about cancer-related Internet information on self-reported outcomes. Two hundred and thirty cancer patients and caregivers completed an online survey regarding their experiences searching for and discussing with their doctors cancer-related Internet information. Participants who assertively introduced the Internet information in a consultation were more likely to have their doctor agree with the information. When doctors showed interest and involvement and took the information seriously, participants were less likely to report a desire to change the doctor's response. Taking the information seriously was also associated with greater satisfaction. This preliminary evidence that the doctor's response is associated with patient outcomes indicates the potential for improving patient-centered communication. In an effort to maximize patient-centered communication, doctors should be encouraged to take their patients and the information they present seriously, as well as show their patients that they are interested and involved. PMID: 20391071 [PubMed - indexed for MEDLINE] 77. Thromb Haemost. 2010 May;103(5):1091-101. doi: 10.1160/TH09-07-0469. Epub 2010 Apr 13. Implementation of SintromacWeb(R), a new internet-based tool for oral anticoagulation therapy telecontrol: Study on system consistency and patient satisfaction. Ferrando F, Mira Y, Contreras MT, Aguado C, Aznar JA. Unidad de Hemostasia y Trombosis, Hospital Universitario La Fe, Valencia, Spain. [email protected] Most computer- or internet-assisted systems for oral anticoagulation therapy (OAT) telemanagement have limitations when it comes to implementation within a healthcare center. It was the objective of this study to evaluate convenience and patient satisfaction with the use of SintromacWeb, a new OAT telecontrol system, compared with the conventional control. SintromacWeb consists of a point-of-care device for patient international normalized ratio (INR) self-testing and software
that allows internet mediated interaction with physicians. Patients initiated the use of SintromacWeb and were followed up during a three-month period. A score-based questionnaire was completed in three controlled visits, and data were subsequently analysed. A total of 102 patients were enrolled. At first visit, 55.7% of the patients had their INR within normal range, and 64.9% at the final visit. Internal consistency of the questionnaire was good (Cronbach's a: 0.79). Scores in the questionnaire were independent of patient's age, education level, working status and INR value. The most valued features of SintromacWeb were: fewer visits to the hospital, simplicity and convenience of the system, and time administration for control tasks (86.7%, 82.7% and 77.6% of very satisfied patients, respectively). Also, patients showed indifference or were dissatisfied with the conventional system. At the final visit, 99% of patients declared that they were satisfied with their OAT control. Moreover, all patients continued using SintromacWeb after completion of the study. In conclusion, SintromacWeb telecontrol is a new model for management of anticoagulated patients. It was highly accepted and can be used by all patients regardless of their sociodemographic characteristics. PMID: 20390224 [PubMed - indexed for MEDLINE] 78. Exp Clin Transplant. 2009 Dec;7(4):225-7. The internet as a tool for patient-centered care in transplantation. Hanif F, Read JC, Gibbs P. University Department of Surgery, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, UK. [email protected] The Internet is a popular communication tool that plays a significant role in patient-centered care. It is argued that a driving force for the demand for online health information is the paucity of information easily obtained from traditional channels. As the quality of medical information available on the Internet is variable, and the quantity is constantly increasing and changing, there is a need for rigorous assessment of quality and effectiveness of health Web sites, and the Internet-based health care support services for different fields of medicine. On one hand, Internet-based patient support tools and Web sites have been used successfully in managing patients with different illnesses like lung transplant, vascular surgery, and treating diabetes mellitus - but on the other hand, other studies have shown that a majority of Web sites providing information on kidney and liver transplant are of poor quality and need overhauling. In the modern world, where e-technology has become common place, patients deserve e-services that are informative, trustworthy, and useful. It is not only a challenge, but also the responsibility of clinicians to make this happen. PMID: 20353371 [PubMed - indexed for MEDLINE] 79. Contemp Clin Trials. 2010 May;31(3):229-34. doi: 10.1016/j.cct.2010.03.003. Epub 2010 Mar 20. Patient internet use surrounding cancer clinical trials: clinician perceptions and responses. Simon C, Schramm S, Hillis S. Department of Internal Medicine, Program in Bioethics and Humanities, Roy J and Lucille A Carver College of Medicine, 500 Hawkins Drive, 1-110 MEB Iowa City, IA 52242-1190, United States. [email protected]
Clinician perceptions of patient internet use related to clinical trials are not well documented. This exploratory study surveyed how cancer care providers at one NCI-designated cancer center viewed patient internet use surrounding cancer trials, including whether it affected patient decision making regarding trial enrollment. The sample included 20 oncologists (59%) and 14 (41%) nurses (n=34). Most clinicians (n=26; 76%) perceived the internet as having an effect on whether or not patients decided to enroll in a cancer trial. Two thirds (n=17; 65%) felt that this effect was positive, including in terms of enhancing patient knowledge of, access to, and enrollment in trials. Clinicians were asked if they ever discussed with their patients the topic of going online to find out more about cancer trials. Over half (n=18; 58%) who responded (n=31) to this item said yes; the rest (n=13; 42%) said no. The majority (n=10; 77%) in the "no" category were among those who reported that the internet had an effect on patient decision making. These data provisionally suggest that clinicians may see the internet as having mostly a positive effect on patient decision making about cancer trials, but that their communication efforts with patients do not always logically follow from this perception. Provider-patient discussion about internet use may be an opportunity for clinicians to contribute to improved patient knowledge of and enrollment in cancer trials. More research is needed to confirm and explain the gap between clinician perception and communication regarding trial-related internet use by cancer patients. Copyright (c) 2010 Elsevier Inc. All rights reserved. PMCID: PMC2858243 PMID: 20227523 [PubMed - indexed for MEDLINE] 80. Can Fam Physician. 2010 Jan;56(1):e4-5. Effects of the Internet on patient consultations. Lussier MT, Richard C. Department of Family Medicine, University of Montreal, Quebec. [email protected] PMCID: PMC2809188 PMID: 20090060 [PubMed - indexed for MEDLINE] 81. Clin Gastroenterol Hepatol. 2010 Apr;8(4):322-8. doi: 10.1016/j.cgh.2009.12.024. Epub 2010 Jan 6. Systematic review of the quality of patient information on the internet regarding inflammatory bowel disease treatments. Langille M, Bernard A, Rodgers C, Hughes S, Leddin D, van Zanten SV. Division of Otolaryngology/Head and Neck Surgery, University of Alberta, Edmonton, Canada. [email protected] BACKGROUND & AIMS: Patients use the Internet as a resource for information about their diseases. A systematic review evaluating the quality of information available for inflammatory bowel disease patients on the Internet regarding treatment options was performed. METHODS: Google was used to identify 50 websites on 3 occasions. A data quality score (DQS) (potential score, 0-76) was developed to evaluate the content of websites that scores patient information on indications, efficacy, and side effects of treatment. Other outcome measures were a 5-point global quality score, a drug category quality score, the DISCERN instrument, a reading grade level score, and information about integrity.
RESULTS: The median DQS was 22, range 0-74, median global quality score was 2.0, and median Flesch-Kincaid reading grade level was 12.0, range 6.9-13.7. Eight websites achieved a global quality score of 4 or 5. The DQS was highly associated with the global quality score (r = 0.82) and the DISCERN instrument (r = 0.89). There was poor association between the DQS and the rank order in all 3 Google searches. Information on funding source (59%) and date of last update (74%) were often lacking. CONCLUSIONS: There is marked variation in the quality of available patient information on websites about the treatment options for Crohn's disease and ulcerative colitis. Few websites provided high quality information. There is a need for high quality accredited websites that provide patient-oriented information on treatment options, and these sites need to be updated regularly. Copyright 2010 AGA Institute. Published by Elsevier Inc. All rights reserved. PMID: 20060070 [PubMed - indexed for MEDLINE] 82. Conf Proc IEEE Eng Med Biol Soc. 2009;2009:5167-70. doi: 10.1109/IEMBS.2009.5332734. Rich internet application system for patient-centric healthcare data management using handheld devices. Constantinescu L, Pradana R, Kim J, Gong P, Fulham M, Feng D. Biomedical and Multimedia Information Technology Research Group, School of Information Technologies, University of Sydney, Australia. [email protected] Rich Internet Applications (RIAs) are an emerging software platform that blurs the line between web service and native application, and is a powerful tool for handheld device deployment. By democratizing health data management and widening its availability, this software platform has the potential to revolutionize telemedicine, clinical practice, medical education and information distribution, particularly in rural areas, and to make patient-centric medical computing a reality. In this paper, we propose a telemedicine application that leverages the ability of a mobile RIA platform to transcode, organise and present textual and multimedia data, which are sourced from medical database software. We adopted a web-based approach to communicate, in real-time, with an established hospital information system via a custom RIA. The proposed solution allows communication between handheld devices and a hospital information system for media streaming with support for real-time encryption, on any RIA enabled platform. We demonstrate our prototype's ability to securely and rapidly access, without installation requirements, medical data ranging from simple textual records to multi-slice PET-CT images and maximum intensity (MIP) projections. PMID: 19963888 [PubMed - indexed for MEDLINE] 83. Isr Med Assoc J. 2009 Sep;11(9):537-41. The e-patient: a survey of israeli primary care physicians' responses to patients' use of online information during the consultation. Giveon S, Yaphe J, Hekselman I, Mahamid S, Hermoni D. Department of Family Medicine, Sharon-Shomron District, Clalit Health Services, Kfar Saba, Israel. [email protected] BACKGROUND: The Internet has transformed the patient-physician relationship by empowering patients with information. Because physicians are no longer the primary gatekeepers of medical information, shared decision making is now
emerging as the hallmark of the patient-physician relationship. OBJECTIVES: To assess the reactions of primary care physicians to encounters in which patients present information obtained from the Internet (e-patients) and to examine the influence of the physicians' personal and demographic characteristics on their degree of satisfaction with e-patients. METHODS: A questionnaire was developed to assess physicians' attitudes to e-patients, their knowledge and utilization of the Internet, and their personal and professional characteristics. Family physicians in central Israel were interviewed by telephone and in person at a continuing medical education course. RESULTS: Of the 100 physicians contacted by phone, 93 responded to the telephone interviews and 50 physicians responded to the questionnaire in person. There was an 85% response rate. The mean age of respondents was 49 years. Most physicians were born in Israel, with a mean seniority of 22 years. Most had graduated in Eastern Europe, were not board certified and were employees of one of the four health management organizations in Israel. Most physicians responded positively when data from the Internet were presented to them by patients (81%). A number of respondents expressed discomfort in such situations (23%). No association was found between physicians' satisfaction in relationships with patients and comfort with data from the Internet presented by patients. CONCLUSIONS: Physicians in this sample responded favorably to patients bringing information obtained online to the consultation. Though it may be difficult to generalize findings from a convenience sample, Israeli family physicians appear to have accepted internet use by patients. PMID: 19960847 [PubMed - indexed for MEDLINE] 84. J Eur Acad Dermatol Venereol. 2010 May;24(5):541-7. doi: 10.1111/j.1468-3083.2009.03462.x. Epub 2009 Oct 21. Internet-supported gathering of treatment data and patient benefits in psoriasis. Langenbruch AK, Schäfer I, Franzke N, Augustin M. CVderm - German Center of Health Services Research in Dermatology, Department of Dermatology and Venereology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. [email protected] BACKGROUND: Studies about health care of psoriasis patients in Germany are predominantly carried out in dermatological centres, which results in a certain selection bias. To collect data from other sources of patients, the German Centre of Health Services Research in Dermatology conducted a series of web-based studies. The extent of how data on health care on psoriasis gathered online vary from paper and pencil data is yet to be explored. OBJECTIVE: 1 To collect reliable treatment and benefit online data from psoriasis patients in Germany. 2 To compare these with data gathered at dermatological centres. METHODS: On the 'psoriasis-hilfe.de' web portal, psoriasis patients were asked to complete the online version of a questionnaire, which has already been used as a paper and pencil version in the national psoriasis study 'PsoHealth'. Subsequently, difference analyses were conducted between the two data sets. RESULTS: The PsoWeb sample (n = 1071) varies to a high extent from the PsoHealth sample (n = 2009) regarding the achievement of treatment goals and treatment satisfaction. Irrespective of age, sex and duration of disease, the online sample showed lower treatment satisfaction and fewer patient-defined benefits. CONCLUSION: The findings suggest that patients in the online sample are less satisfied with their health care, which also could have been their motive for participating online. It is important to gather data online because it increases the data pool and permits inclusion of people who are not incorporated in clinical settings. However, online data cannot directly replace data collected in clinics because they are also subject to selections. PMID: 19845821 [PubMed - indexed for MEDLINE]
University of Maryland, College Park, Maryland, USA. [email protected] A qualitative, exploratory study was conducted in the summer of 2007 to investigate older adults' preferences for health information and participation in decision making. The study involved in-depth individual and focus group interviewing with a total of 20 older Internet users and nonusers. Grounded theory was used to conduct the data analysis and construct the theory that best explains the data. The concept of health information wants (HIW), or health information that one would like to have and use to make important health decisions that may or may not be directly related to diagnosis or standard treatment, emerged from the data analysis and led to the development of the HIW framework. This framework encompasses four types of HIW that have varying properties and positions on the decision-making spectrum. While Internet use has not changed these older adults' reliance on medical professionals for diagnostic or standard treatment decisions (and reliance on professionals for information needed to make those decisions), it has opened up new venues for obtaining information to make decisions in broader scopes. Thus, both the Internet and the perpetuating influence of the provider-dependent model are at play in the patient-provider relationships of these older adults. PMID: 19731124 [PubMed - indexed for MEDLINE] 88. Inform Health Soc Care. 2009 Sep;34(3):136-48. doi: 10.1080/17538150903102422. Physicians' perception of the effects of Internet health information on the doctor-patient relationship. Kim J, Kim S. College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea. [email protected] The objective of the study was to determine physician's perception of the effects of health information on the internet on doctor-patient relationship. Online questionnaire with 25 items were sent to the Korean physicians' e-mail, and 493 replied. Eight-nine percent of the Korean physicians reported they had experiences of patients discussing the Internet health information. They perceived that Internet health information may enhance the patients' knowledge about their health. However, they perceived that Internet health information may have variety of negative effects such as; heightening the cost of health care by adopting the inappropriate health service utilisation (56.2%); making the patients over-concerned about their health (74.5%); damaging the time efficiency of the visit (60.9%). The physicians deemed that those informations were not relevant to the patients' health condition (42.7%), and even were not correct(39.0%). Physicians' perception of the Internet health information is both positive and negative, and they perceive the overall effects on doctor-patient relationship as neutral. More physicians think the discussion could be the hindrance on the efficient time management during their visits. However, more physicians have positive perception of the effects on the quality of care and patient outcomes which is promising. PMID: 19670004 [PubMed - indexed for MEDLINE] 89. Curr Med Res Opin. 2009 Aug;25(8):2043-8. doi: 10.1185/03007990903103006. Patient insight into the impact of chronic obstructive pulmonary disease in the morning: an internet survey. Partridge MR, Karlsson N, Small IR. Imperial College London, NHLI Division, Charing Cross Hospital, London W6 8RP, UK. [email protected] Erratum in Curr Med Res Opin. 2012 Aug;28(8):1405. OBJECTIVE: To determine diurnal variability of symptoms in chronic obstructive pulmonary disease (COPD) and to assess the impact of COPD upon patients' morning activities and routines. RESEARCH DESIGN AND METHODS: Quantitative internet interviews with 803 COPD patients from Europe and the USA, including 289 patients with severe COPD. Severe COPD was defined according to regular use of COPD medication, third level of breathlessness or above using the modified Medical Research Council (MRC) dyspnoea scale (MRC dyspnoea score > or =3) and one or more COPD exacerbations in the preceding 12 months. RESULTS: Morning was the worst time of day for COPD symptoms, particularly in patients with severe COPD (reported by 46% of severe patients). In these patients, shortness of breath was the most frequently reported symptom, correlating strongly with problems experienced with morning activities. Morning activities most affected by COPD were walking up and down stairs, putting on shoes and socks, making the bed, dressing, showering or bathing and drying. The majority of patients were not taking their medication in time for it to exert its optimal effect. CONCLUSIONS: Many patients consider the impact of COPD on morning activities to be substantial. Physicians should question patients about morning activities to assess disease impact and to advise regarding the optimal time to use therapy. This was an internet-based questionnaire survey and possible bias in patient selection and self-reported diagnosis of COPD and its severity should be taken into account. PMID: 19569976 [PubMed - indexed for MEDLINE] 91. Health Expect. 2009 Sep;12(3):313-20. doi: 10.1111/j.1369-7625.2009.00543.x. Epub 2009 Jun 25.
Patient perspectives on health advice posted on Internet discussion boards: a qualitative study. Armstrong N, Powell J. Social Science Research Group, Department of Health Sciences, University of Leicester, Leicester, UK. [email protected] BACKGROUND: Use of the Internet for health information by patients is growing, and there have been diverse responses to this both within the research community and the medical and health-related professions. The use of Internet discussion boards are one way that people living with long-term conditions can interact with their peers and offer and seek advice, support and information. We report patient perspectives on using a discussion board within a wider pilot study of an Internet-based self-management system for diabetes. DESIGN: Qualitative data was gathered during three stages of developing and piloting the wider self-management system. These are: (1) patient focus groups as part of a stakeholder consultation; (2) a pre-test session and focus group; and 3. a 6-month pilot study including follow-up individual interviews. RESULTS: Three main themes were identified within participants' perspectives on Internet discussion boards. First, a focus on the importance and value of peer support to these patients. Secondly, participants' awareness of the need to evaluate the information posted by others in light of their own circumstances. Thirdly, the value placed upon the experiential knowledge of others living with the same condition. CONCLUSIONS: Many people living with long-term conditions would like to be in contact with their peers, and Internet discussion boards represent a cost-effective and interactive way of achieving this. Within the context of diabetes, the knowledge and expertise accumulated over many years of self-management is central to participants' self-reported ability to evaluate information posted and make decisions on its possible use. PMID: 19555377 [PubMed - indexed for MEDLINE] 92. J Thromb Haemost. 2009 Aug;7(8):1284-90. doi: 10.1111/j.1538-7836.2009.03497.x. Epub 2009 May 30. Randomized controlled trial of supervised patient self-testing of warfarin therapy using an internet-based expert system. Ryan F, Byrne S, O'Shea S. Pharmaceutical Care Research Group, University College Cork, Cork, Ireland. BACKGROUND: Increased frequency of prothrombin time testing, facilitated by patient self-testing (PST) of the International Normalized Ratio (INR) can improve the clinical outcomes of oral anticoagulation therapy (OAT). However, oversight of this type of management is often difficult and time-consuming for healthcare professionals. This study reports the first randomized controlled trial of an automated direct-to-patient expert system, enabling remote and effective management of patients on OAT. METHODS: A prospective, randomized controlled cross-over study was performed to test the hypothesis that supervised PST using an internet-based, direct-to-patient expert system could provide improved anticoagulation control as compared with that provided by an anticoagulation management service (AMS). During the 6 months of supervised PST, patients measured their INR at home using a portable meter and entered this result, along with other information, onto the internet web page. Patients received instant feedback from the system as to what dose to take and when the next test was due. During the routine care arm, patients attended the AMS at least every 4-6 weeks and were dosed by the anticoagulation pharmacist or physician. The primary outcome variable was the difference in the time in therapeutic range (TTR) between both arms. RESULTS: One hundred and sixty-two patients were enrolled (male 61.6%, mean age 58.7 years), and 132 patients (81.5%) completed both arms. TTR was significantly higher during PST management than during AMS management (median TTR 74% vs 58.6%; z=5.67, P < 0.001). CONCLUSIONS: The use of an internet-based, direct-to-patient expert system for the management of PST improves the control of OAT as compared with AMS management. PMID: 19496921 [PubMed - indexed for MEDLINE] 93. Am J Mens Health. 2008 Jun;2(2):106-21. doi: 10.1177/1557988306296156. Epub 2007 May 23. The Internet as an emerging patient education tool among African American men with prostate cancer: an exploratory study. Wallington SF. Dana Farber Cancer Institute/Harvard School of Public Health, Boston, MA 02115, USA. [email protected] The lives of African American men with prostate cancer are greatly influenced by the information available to them, some of which is accessed on the Internet. Research indicates that the Internet can enhance consumer health knowledge but has not reached socioeconomic groups at highest risk for health disparities, such as African American men with prostate cancer. In this study, focus groups were used to explore the perceptions and uses of the Internet as a patient education tool among 39 African American men aged 39 years and older with diverse socioeconomic backgrounds. Nineteen (49%) participants reported using the Internet, 15 (38%) reported no use but indicated it was used on their behalf, and 5 (13%) reported no use and no use on their behalf. The findings revealed varying degrees of Internet use
for information and social support. Prostate cancer diagnosis, poor patient-doctor communications, and accessibility influenced Internet use. Accessibility related more to lack of ease and familiarity with Internet use than lack of computer access. With training and awareness, the Internet has potential as a patient education tool among African American men with prostate cancer. PMID: 19477775 [PubMed - indexed for MEDLINE] 93. Ann Pharmacother. 2009 May;43(5):899-907. doi: 10.1345/aph.1L688. Efficacy of natural health products in treating osteoporosis: what is the quality of internet patient advice? Whelan AM, Jurgens TM, Bowles SK, Doyle H. College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada. [email protected] BACKGROUND: With Canadians increasing their use of the Internet to find health-related information, especially regarding natural health products (NHPs), there is a need for high-quality, evidence-based information on Web sites to aid consumers in making informed decisions regarding the appropriate and safe use of NHPs. OBJECTIVE: To determine the quality of Web sites that target consumers and advocate the use of NHPs in the management of osteoporosis in postmenopausal women. METHODS: Web sites were identified via the Google search engine using the key words "natural treatment osteoporosis." The first pages of the first 91 Web sites identified were assessed for relevance based on the following criteria: (1) written in English, (2) contained consumer information, and (3) claimed a benefit of a single NHP in the management of osteoporosis. This task was completed by 2 investigators; differences were resolved by consensus after discussion with the third investigator. Quality of relevant sites was assessed using an expanded DISCERN instrument that also examined the evidence supporting the claim of benefit. Additionally, readability of the sites was assessed. RESULTS: Thirty-eight Web sites met the inclusion criteria. Using the DISCERN instrument, we found that many of the sites scored low, suggesting serious or extensive shortcomings. On many Web sites, benefit claims regarding calcium, vitamin D, phytoestrogens, dehydroepiandrosterone and vitamin K were consistent with empirical evidence. However, for other NHPs, many of these same sites made effectiveness claims that were not supported by current evidence from randomized controlled trials. Twenty-five sites did not provide information as to what resources were used to support their claims. The average reading grade score was grade 11.9 (based on US school grades) and the mean Flesch Reading Ease Score was 41.7. (A higher score out of 100 indicates ease of reading.) CONCLUSIONS: Due to the poor quality and content from unknown sources found on some Web sites, consumers who access Web sites for information regarding the use of NHPs in osteoporosis should do so cautiously and discuss results with their healthcare providers. PMID: 19417114 [PubMed - indexed for MEDLINE] 94. Ann Pharmacother. 2009 Apr;43(4):732-9. doi: 10.1345/aph.1L580. Epub 2009 Mar 24. Patient needs and sources of drug information in Singapore: is the Internet replacing former sources? Ho CH, Ko Y, Tan ML. Department of Pharmacy, National University of Singapore, Singapore. BACKGROUND: Patients are exposed to a broad range of drug information (DI) sources; among them is the Internet, which has been increasingly used over the years, especially by adolescents. OBJECTIVE: To identify patients' needs and common sources of DI; examine the differences in use of DI sources among groups, by age and sex; and better understand patients' use of the Internet as a source of DI. METHODS: A quota sample of 201 outpatients from National University Hospital in Singapore was surveyed. A questionnaire was developed to examine patients' needs for and common sources of DI as well as their experience with and attitudes toward using the Internet as a DI source. RESULTS: Physicians (83.1%) and pharmacists (57.7%) were reported to be the most commonly used sources of DI regarding prescription drugs (n = 201), whereas pharmacists (40.9%) and relatives or friends (40.9%) were the most commonly reported sources for information about nonprescription drugs (n = 149). Respondents most commonly sought DI about adverse effects (72.6%), dosing (54.7%), and indications (54.2%). Among Internet users, people aged 31-50 years were more likely than those in other age groups to search the Internet for DI (p < 0.001). The Internet was considered to be a convenient source with a broad range of information; however, patients faced both the inability to find needed information and uncertainty about information reliability when searching for DI on the Internet. CONCLUSIONS: Pharmacists play an important role in counseling patients abo prescription and nonprescription drugs. There is a need to educate patients on how to locate and evaluate DI on the Internet. PMID: 19318597 [PubMed - indexed for MEDLINE] 95. Anaesthesia. 2009 Apr;64(4):408-15. doi: 10.1111/j.1365-2044.2008.05813.x.
Patient information about general anaesthesia on the internet. Tallgren M, Bäcklund M. Department of Anaesthesia and Intensive Care Medicine, Helsinki University Hospital, 00029 Helsinki, Finland. [email protected] The internet is a frequently consulted source of health information. Using the Google search engine, we searched for patient information about general anaesthesia on the world wide web, using four synonyms of the term in four languages and analysing the top 20 results. Of the 320 search results, 104 (32%) contained relevant information: 36 (45%) with the English (UK); 39 (49%) with the English (US); 13 (16%) with the Swedish; and 16 (20%) with the Finnish search terms (p < 0.001). 'Good' websites, defined as those with a DISCERN rating of 4-5 stars, were found in all languages: 12 with the English (UK); 11 with the English (US); two with the Swedish; and one with the Finnish search terms (p = 0.012). Few good websites showed a reading grade level of < or = 8 that is recommended for consumer health information. Of the good quality sites, 18/22 (82%) remained within the top 20, three months later. PMID: 19317707 [PubMed - indexed for MEDLINE] 96. Orthopedics. 2009 Jan;32(1):13. Treating the Internet-informed Patient. D'Ambrosia RD. PMID: 19226046 [PubMed - indexed for MEDLINE] 97. J Adv Nurs. 2009 Mar;65(3):596-605. doi: 10.1111/j.1365-2648.2008.04921.x. Representations of heart failure in Internet patient information. Strong AL, Gilmour JA. Cardiology Department, Hutt Valley District Health Board, New Zealand. [email protected] AIM: This paper is a report of a study which examined representations of heart failure in Internet patient information. BACKGROUND: The Internet is a popular tool for sourcing health information and has been shown to benefit people with chronic conditions. Nurses as users and producers of Internet health information need to be critical of the information they provide and how this information is portrayed, to support patient knowledge development and decision-making. METHOD: A critical discourse analysis approach was used to examine representations of heart failure in a range of Internet texts. Data were collected from eight websites over 5 days in July 2006. FINDINGS: The two major discursive representations evident in the heart failure texts were labelled 'living with heart failure' and 'biomedical' discourses. While both discourses were evident in all of the Internet sites, most sites privileged the biomedical discourse. Absences from the Internet information included the visibility and role of nurses along with emotional and spiritual dimensions of heart failure. CONCLUSION: Nurses should take individual needs into consideration and be able to critique websites before suggesting appropriate sites to patients. Nurses and consumers can enhance the quality of websites by becoming involved in their development to ensure that all factors that affect health are included, such as the emotional and spiritual aspects of living with heart failure and not just topics that are important within a biomedical view of health. PMID: 19222657 [PubMed - indexed for MEDLINE] 98. Swiss Med Wkly. 2008 Dec 13;138(49-50):728. doi: 2008/49/smw-12595. Patient empowerment through the internet. Neftel K. Comment on Swiss Med Wkly. 2008 Dec 13;138(49-50):741-5. PMID: 19130325 [PubMed - indexed for MEDLINE] 99. Genet Med. 2008 Dec;10(12):895-902. doi: 10.1097/GIM.0b013e31818de708. Patient interest in recording family histories of cancer via the Internet. Simon C, Acheson L, Burant C, Gerson N, Schramm S, Lewis S, Wiesner G. Department of Bioethics, Case Western Reserve University, Cleveland, Ohio, USA. [email protected] PURPOSE: This study investigated the interest of mammogram patients in using electronic tools for recording their family histories of cancer (FHC).
METHODS: Semistructured interviews were conducted with 65 patients visiting a breast center at a referral hospital in Cleveland, Ohio. RESULTS: Most (n = 40; 62%) respondents expressed interest in using an electronic tool for recording FHC and associated its use with a range of benefits to themselves, their families, and their health care providers. Women who were not interested (n = 25; 38%) in using an electronic tool for recording FHC were concerned about privacy issues, computer proficiency, and giving up the opportunity to provide family history information directly to the health care provider. Interest in using an electronic tool for recording FHC was not significantly associated with age, race, level of education or income, personal or FHC, or Internet access and frequency of use. CONCLUSION: Electronic documentation of FHC was seen as largely desirable. However, clinical services to facilitate systematic family history documentation are likely to require more than one avenue for collecting and communicating this information, as not everyone who wants to provide a FHC to a health care provider is comfortable using the Internet to do so. PMCID: PMC3342847 PMID: 19092442 [PubMed - indexed for MEDLINE] 100. J Am Osteopath Assoc. 2008 Dec;108(12):699-711. Impact of internet use on health-related behaviors and the patient-physician relationship: a survey-based study and review. Iverson SA, Howard KB, Penney BK. Mount Clemens Regional Medical Center in Mich, USA. [email protected] CONTEXT: Although patient use of online resources to locate health-related information is increasing, few large-scale studies investigating ramifications to patient health and the patient-physician relationship have been conducted in primary care or osteopathic medical settings. OBJECTIVES: To describe online health information-seeking behaviors among patients. To evaluate the effects of this information on patient self-care and the patient-physician relationship. METHODS: A standardized eight-question survey regarding Internet use and healthcare was given to patients at three osteopathic primary care medical clinics. A review of the literature is also included. RESULTS: Of 154 patient responses received, 89 patients (58%) reported using the Internet to find health information. Slightly more than half of these individuals (49 [55%]) reported a change in the way they think about their health as a result of that information. In addition, most of these individuals (41 [46%]) reported making subsequent health-related behavioral changes. The largest segment of this population was aged 31 to 45 years (17 [57%]). They reported asking more questions during office visits (27 [66%]), following physician advice more closely (22 [54%]), and making self-directed dietary changes (22 [54%]). By and large, these patients informed their physicians of these changes (30 [73%]), especially as they believed physicians were willing to discuss the health information they obtained online (75 [84%]). CONCLUSION: Although many concerns have been expressed about resulting changes inpatient-physician dynamics, online information gathering has the potential to foster greater patient engagement in health maintenance and care. PMID: 19075034 [PubMed - indexed for MEDLINE] 101. Med Health R I. 2008 Oct;91(10):326. Internet prescribing and the physician patient relationship. Jeha J, Crausman RS. RI Department of Health, USA. PMID: 19044111 [PubMed - indexed for MEDLINE] 102. Neurologist. 2008 Nov;14(6):374-81. doi: 10.1097/NRL.0b013e31817709bb. Why patients go online: multiple sclerosis, the internet, and physician-patient communication. Hay MC, Strathmann C, Lieber E, Wick K, Giesser B. Department of Anthropology, Miami University, Oxford, OH 45056, USA. [email protected] BACKGROUND: The online information seeking of multiple sclerosis (MS) patients, their reasons for doing so, and its importance for physician-patient communication have not been described. METHODS: Patients (n = 61) presenting for the first time at an MS clinic from December 2003 to July 2005 were interviewed pre- and postappointment and administered standard measures of pain and health quality of life. Consultations were audio recorded. Quantitative data were analyzed in light of qualitative data. RESULTS: Eighty-two percent of patients reported gathering medical information online before their first appointment; 36% discussed this information with their physician. Qualitative reasons for Internet information seeking and for not communicating it show some signs of wariness of health care potentially leading to nonadherence. CONCLUSIONS: Most MS patients are informed by online information, but are unlikely to discuss that research with physicians for reasons that may have implications for patient adherence.
PMID: 19008743 [PubMed - indexed for MEDLINE] 103. J Rheumatol. 2009 Jan;36(1):41-9. doi: 10.3899/jrheum.080430. Patient-oriented methotrexate information sites on the Internet: a review of completeness, accuracy, format, reliability, credibility, and readability. Thompson AE, Graydon SL. Department of Medicine, University of Western Ontario, Rheumatology Centre, St. Joseph's Health Care, 268 Grosvenor Street, PO Box 5777, London, ON, Canada, N6A 4V2. [email protected] Comment in J Rheumatol. 2009 Jan;36(1):1-3. OBJECTIVE: With continuing use of the Internet, rheumatologists are referring patients to various websites to gain information about medications and diseases. Our goal was to develop and evaluate a Medication Website Assessment Tool (MWAT) for use by health professionals, and to explore the overall quality of methotrexate information presented on common English-language websites. METHODS: Identification of websites was performed using a search strategy on the search engine Google. The first 250 hits were screened. Inclusion criteria included those English-language websites from authoritative sources, trusted medical, physicians', and common health-related websites. Websites from pharmaceutical companies, online pharmacies, and where the purpose seemed to be primarily advertisements were also included. Product monographs or technical-based web pages and web pages where the information was clearly directed at patients with cancer were excluded. Two reviewers independently scored each included web page for completeness and accuracy, format, readability, reliability, and credibility. An overall ranking was provided for each methotrexate information page. RESULTS: Twenty-eight web pages were included in the analysis. The average score for completeness and accuracy was 15.48+/-3.70 (maximum 24) with 10 out of 28 pages scoring 18 (75%) or higher. The average format score was 6.00+/-1.46 (maximum 8). The Flesch-Kincaid Grade Level revealed an average grade level of 10.07+/-1.84, with 5 out of 28 websites written at a reading level less than grade 8; however, no web page scored at a grade 5 to 6 level. An overall ranking was calculated identifying 8 web pages as appropriate sources of accurate and reliable methotrexate information. CONCLUSION: With the enormous amount of information available on the Internet, it is important to direct patients to web pages that are complete, accurate, readable, and credible sources of information. We identified web pages that may serve the interests of both rheumatologists and patients. PMID: 19004031 [PubMed - indexed for MEDLINE] 104. J Cardiovasc Nurs. 2008 Nov-Dec;23(6):472-3. doi: 10.1097/01.JCN.0000338938.56038.6a. Understanding how the patient interacts with Internet intervention is key to advancing telemedicine. Santamore WP, Homko CJ. Department of Physiology, School of Medicine, Temple University, Philadelphia, Pennsylvania 19140, USA. [email protected] Comment on J Cardiovasc Nurs. 2008 Nov-Dec;23(6):463-71. PMID: 18953207 [PubMed - indexed for MEDLINE] 105. Patient Educ Couns. 2008 Dec;73(3):557-60. doi: 10.1016/j.pec.2008.07.046. Epub 2008 Sep 11. Can people find patient decision aids on the Internet? Morris D, Drake E, Saarimaki A, Bennett C, O'Connor A. Ottawa Health Research Institute, Ottawa, Canada. [email protected] OBJECTIVE: To determine if people could find patient decision aids (PtDAs) on the Internet using the most popular general search engines. METHODS: We chose five medical conditions for which English language PtDAs were available from at least three different developers. The search engines used were: Google (www.google.com), Yahoo! (www.yahoo.com), and MSN (www.msn.com). For each condition and search engine we ran six searches using a combination of search terms. We coded all non-sponsored Web pages that were linked from the first page of the search results. RESULTS: Most first page results linked to informational Web pages about the condition, only 16% linked to PtDAs. PtDAs were more readily found for the breast cancer surgery decision (our searches found seven of the nine developers). The searches using Yahoo and Google search engines were more likely to find PtDAs. The following combination of search terms: condition, treatment, decision (e.g. breast cancer surgery decision) was most successful across all search engines (29%). CONCLUSION: While some terms and search engines were more successful, few resulted in direct links to PtDAs. PRACTICE IMPLICATIONS: Finding PtDAs would be improved with use of standardized labelling, providing patients with specific Web site addresses or access to an independent PtDA clearinghouse. PMID: 18789628 [PubMed - indexed for MEDLINE]
Swinburne University of Technology, Faculty of Life and Social Sciences, Mail H31, PO Box 218, Hawthorn, Victoria 3122, Australia. [email protected] BACKGROUND: Mental illness is an escalating concern worldwide. The management of disorders such as anxiety and depression largely falls to family doctors ogeneral practitioners (GPs). However, GPs are often too time constrained and may lack the necessary training to adequately manage the needs of such patients. Evidence-based Internet interventions represent a potentially valuable resource to reduce the burden of care and the cost of managing mental health disorders within primary care settings and, at the same time, improve patient outcomes. OBJECTIVE: The present study sought to extend the efficacy of a therapist-assisted Internet treatment program for panic disorder, Panic Online, by determining whether comparable outcomes could be achieved and maintained when Panic Online was supported by either GPs or psychologists. METHODS: Via a natural groups design, 96 people with a primary diagnosis of panic disorder (with or without agoraphobia) completed the Panic Online program over 12 weeks with the therapeutic assistance of their GP (n = 53), who had received specialist training in cognitive behavioral therapy, or a clinical psychologist (n = 43). Participants completed a clinical diagnostic telephone interview, conducted by a psychologist, and a set of online questionnaires to assess panic-related symptoms at three time periods (pretreatment, posttreatment, and 6 month follow-up). RESULTS: Both treatments led to clinically significant improvements on measures of panic and panic-related symptomatology from pretreatment to posttreatment. Both groups were shown to significantly improve over time. Improvements for both groups were maintained at follow-up; however, the groups did differ significantly on two quality of life domains: physical (F(1,82) = 9.13, P = .00) and environmental (F(1,82) = 4.41, P = .04). The attrition rate was significantly higher among those being treated by their GP (chi(2) (1) = 4.40, P = .02, N = 96). CONCLUSIONS: This study provides evidence that Internet-based interventions are an effective adjunct to existing mental health care systems. Consequently, this may facilitate and enhance the delivery of evidence-based mental health treatments to increasingly large segments of the population via primary care systems and through suitably trained health professionals. PMCID: PMC2483919 PMID: 18487138 [PubMed - indexed for MEDLINE]
