Patient empowerment and the use of Internet

Steinar Pedersen

Ottawa Charter (WHO 1986)

• The idea of a process that enables people to ”increase control over, and to improve, their health”

• (Information therapy)

Patients and level of care

Personsper month Level of care

2 University hospital 13 Local hospital

150 GP

500 Self care

85 Symptoms, no treatment 250 No symptoms

1000 Population

Diagnosing the doctor-patient relationship

• Doctors do more talking than listening. One study found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds.

• And that doctors failed to elicit 54% of patients’ reasons for wanting a consultation and 45% of their worries.

• In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients, but believed they were spending 9 minutes per visit doing so.

Seaman summarizes • Doctors tend to perceive illness as a disease process that

can be measured and understood through laboratory tests and clinical observations. – To the patient, illness is a disrupted life.

• Doctor’s tend to focus more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. – Yet patient satisfaction comes primarily from a sense of being

heard and understood.

• Many doctors do not see the role of physician as listener, but instead view their function as: find it, and fix it. – Yet patients often feel devalued when their illness is reduced

to a mechanical process.

So the sharing of health issues with “strangers” may be a symptom of

dysfunctional doctor-patient

relationships.

The experience of discussing personal problems…

0

5

10

15

20

25

30

35

40

Serie1 24,4 36 29,9 6,5 3,2

Very easy Easy Medium Difficult Very difficult

0

5

10

15

20

25

30

35

40

Serie1 3,4 13,7 27,2 34 21,7

Very easy Easy Medium Difficult Very difficult

…on the Internet …face to face

• 75 percent find it easier to discuss personal problems in a discussion group online.• 46 percent claim they address issues online that they would not discuss otherwise.

Source: Kummervold et al. 2001

• Who would have guessed that passionate, intimate relationships would be established and maintained through hopelessly clumsy user interfaces like SMS and computers?

Health information and the Internet

19

31 28

15

2

51 5158

4740

9

28

47

3832

0

10

20

30

40

50

60

70

Total 15-29 30-44 45-59 60+

2000

2001

2002

%

Fox and Rainie (2002)

• Roughly 80% of the health seekers find the information they need on the Internett

Wanted e-Mail contact with the doctor

Alder

52

40

26

4

63

42

18

50

60

22

6359

0

10

20

30

40

50

60

70

80

15-29 30-44 45-59 60+

200020012002

• The physicians are today (reluctantly) accommodate patients wanting to interact electronically.

• But “If you can’t beat them, write them” may be the order of the day.

The new patient role• The well informed

patient• Empowerment• From “thank you” to

“why”• From passive recipient

to active participant• And they will use the

net!!!I’m sorry doctor, but again I have to disagree

Characteristics: The eHealth Consumer

• 1/3 of the population in Norway

• Higher education• Young adults• Higher income• Equal use among woman

and men

• The well-educated and well-off have access to and use the Internet to a much greater extent than those who are less well-educated and who are less well-off

Types of use

Discussion forums, self help groups

Questions to health personell

Information

Internet based self-help for breast cancer operated women

Preliminary results

• Available when they need it

• The net group has become their most important resource in their meeting with their own disease

• Bench marketing of the health care system

Effects on patients’ behaviour towards their doctors

N=476

Delayed, altered, or cancelled appointment

Scheduled new appointment

Attempted to decide own diagnosis

Posed more specific questions to their doctor

Effects on health consumers everyday self-care

N=476 (2001)

Change of diet or other lifestyle related behaviours

Experienced anxiety

Experienced relief

Heart patients

The Journal of the Norwegian Medical Association

• Results from a 14 articles meta- analysis show that the death rate is reduced with 30 %

• The main feature of the Internet is said to be its accessibility and interactivity

Key global telecom indicators

0

200

400

600

800

1000

1200

1992 2002

Main telephonelinesMobilesubscribersPCs

Internet users

Phone vs Internet

• In the UK, the Samaritans report that although only 20% of telephone callers report suicidal feelings, this number increases to around 50% of e-mail contacts.

• This phenomenon appears particularly relevant for those who feel stigmatised, shameful, and/or suffer from low self-esteem.

The use of Internet

0

500

1000

1500

2000

2500

3000

3500

Users/ 10.000

Africa (99)Americas (2421)Asia (558)Europe (2079)Oceania (3330)World (972)

Summary

• Knowledge is power, sharing is wisdom