Health information on the Internet: accessibility, quality, and readability in English and Spanish

Evaluation of asthma websites for patient and parent education

The purpose of this study was to evaluate the quality of websites on asthma for patient and parent education. Seventy websites were evaluated based on the Health Information Technology Institute (HITI) criteria; eight core content criteria from the National Heart, Lung, and Blood Institute guidelines; and readability. The ten best websites for asthma education were identified for patient teaching and educating parents about asthma.

Design and testing of a tool for evaluating the quality of diabetes consumer-information Web sites

BACKGROUND

Most existing tools for measuring the quality of Internet health information focus almost exclusively on structural criteria or other proxies for quality information rather than evaluating actual accuracy and comprehensiveness.

OBJECTIVE

This research sought to develop a new performance-measurement tool for evaluating the quality of Internet health information, test the validity and reliability of the tool, and assess the variability in diabetes Web site quality.

METHODS

An objective, systematic tool was developed to evaluate Internet diabetes information based on a quality-of-care measurement framework. The principal investigator developed an abstraction tool and trained an external reviewer on its use. The tool included 7 structural measures and 34 performance measures created by using evidence-based practice guidelines and experts' judgments of accuracy and comprehensiveness.

RESULTS

Substantial variation existed in all categories, with overall scores following a normal distribution and ranging from 15% to 95% (mean was 50% and median was 51%). Lin's concordance correlation coefficient to assess agreement between raters produced a rho of 0.761 (Pearson's r of 0.769), suggesting moderate to high agreement. The average agreement between raters for the performance measures was 0.80.

CONCLUSIONS

Diabetes Web site quality varies widely. Alpha testing of this new tool suggests that it could become a reliable and valid method for evaluating the quality of Internet health sites. Such an instrument could help lay people distinguish between beneficial and misleading information.

Conceptual framework for a new tool for evaluating the quality of diabetes consumer-information Web sites

BACKGROUND

Most existing tools for measuring the quality of Internet health information focus almost exclusively on structural criteria or other proxies for quality of information, rather than evaluating information accuracy and comprehensiveness.

OBJECTIVE

This research sought to build a conceptual framework that could lay the groundwork for a robust performance-measurement system for evaluating the quality of Internet health information.

METHODS

Application of the quality-of-care measurement paradigm to developing a conceptual framework for defining and evaluating the quality of diabetes consumer-information Web sites.

RESULTS

Performance measures related to accuracy and comprehensiveness of information can be added to structural criteria to provide a more-robust approach to Web site evaluation.

CONCLUSIONS

The development and implementation of a reliable and valid method for evaluating the quality of Internet health sites could provide lay people with a tool to identify useful content more easily and distinguish between beneficial and misleading information.

Future history: medical informatics in geriatrics

With deference to Isaac Asimov's The Foundation, which is the inspiration for this series, we briefly describe the "present history" of medical informatics (the application of information technology in medicine) in geriatrics, and then project a "future history" of this same endeavor. The older patient often has multiple acute and chronic problems that require management by a variety of medical professionals in a variety of settings. Proper care necessitates efficient gathering, integration, and management of information by each professional in each setting. As medical informatics evolves, we project that barriers to information exchange (both between providers and between providers and patients) will continue to decrease while the quality and relevance of exchanged information will continue to increase. The nexus of care will be the electronic medical record (EMR), which will shed its current paper chart metaphor and adopt an industrial process metaphor based on tasks and tolerances or goals. The multidisciplinary management of geriatric patients will strike a new balance: doctors, nurses, allied health professionals, family, and patients will all participate in the management of the patient's care. The EMR will coordinate data from a variety of novel sources, including wearable sensors monitoring physiologic parameters, falls, diet, ambulation, and medication compliance. The highly organized data in the EMR will allow explicit decision support for computer-facilitated, evidence-based care; will empower midlevel providers and patients with an increased role in the care plan; and will promote the realignment of care from hospitals/clinics to the patient's home.

The Use of a World Wide Web-based Consultation Site to Provide Support to Telephone Staff in a Traumatic Brain Injury Demonstration Project

OBJECTIVES

Distance from expertise in traumatic brain injury (TBI) is often an impediment to appropriate TBI care from local health care providers, especially in rural areas. To overcome this barrier to care and to support a randomized, controlled trial of telephone follow-up after discharge from acute rehabilitation, we demonstrated the use of a confidential consultation Web site to provide expert recommendations and advice to front-line telephone staff at a different site.

CONCLUSIONS

This use of Internet communication proved convenient to all users, improved client confidence, and served as an excellent training tool to less experienced staff. In addition, use of a Web-based consultation method provided for archiving of all discussions for later review.

E-medicine and health care consumers: recognizing current problems and possible resolutions for a safer environment

Millions of Americans access the Internet for health information, which is changing the way patients seek information about, and often treat, certain medical conditions. It is estimated that there may be as many as 100,000 health-related Web sites. The availability of so much health information permits consumers to assume more responsibility for their own health care. At the same time, it raises a number of issues that need to be addressed. The health information available to Internet users may be inaccurate or out-of-date. Potential conflicts of interest result from the blurring of the distinction between advertising and professional health information. Also, potential threats to privacy may result from data mining. Health care consumers need to be able to evaluate the quality of the information provided on the Internet. Various evaluative mechanisms such as codes of ethics, rating systems, and seals of approval have been developed to aid in this process. The effectiveness of these solutions is evaluated in this paper. Finally, the paper addresses the importance of including patients in developing standardized quality assurance systems for online health information.

Inguinal hernia on the internet: a critical comparison of Germany and the UK

Despite containing an increasing amount of medical information, the Internet provides only rare benefits for surgical patients. Using "inguinal hernia" as a catchword, an amateur search was imitated on the British Internet market. Sixty-five pages, standardised regarding quality and efficiency, were evaluated. A comparison to the German Internet market was added. In summary, the broad majority of the pages revealed poor results. Technical appearance, quality of content, and target grouping show big deficiencies. The applicable laws on the European market are not yet established. The ranking lists of the search engines do not reflect the quality of the pages. Patients need competent guides to process surgical information from the Internet. The establishment of specialised institutions to control surgical Web sites according to quality, content, and legality on the European level is urgent.

Important drug safety information on the internet: assessing its accuracy and reliability

BACKGROUND

The Internet is becoming increasingly important as a source of health-related information, but the accuracy and reliability of information presented on the world wide web is debated.

OBJECTIVE

We aimed to assess whether important, recent drug safety information is accurately reflected on Internet sites.

METHODS

We evaluated whether major warnings issued by the US FDA between October 1, 2000 and September 30, 2001 on severe and life-threatening drug toxicity were mentioned 4-16 months later in the top ten web pages identified for these drugs by each of seven different search engines. We examined predictors of precise mention of the FDA warnings using logistic regressions.

RESULTS

Twenty major safety warnings on 21 drugs (including three withdrawals) were eligible for the study. Among 519 different pertinent web pages retrieved (16-32 for each drug), precise mention of the safety issue was made in only 165 (31.8%). Best rates of precise mention were seen in web sites sponsored by attorneys (79.4%), in physician-oriented web pages (65.5%) and for withdrawn drugs (57.9%). In addition to these factors, better coverage of the FDA warnings was independently seen when no other adverse effects from the same organ system was mentioned (p < 0.001), while coverage was worse when there was no date on the site and web page (p = 0.020), and when the site owner could not be classified or was unknown (p = 0.014).

CONCLUSIONS

Important safety warnings are inadequately covered in the majority of web pages. This deficiency creates a source of potentially harmful misinformation for health consumers.

Producing an information leaflet to help patients access high quality drug information on the Internet: a local study

OBJECTIVES

To develop a patient information leaflet (PIL) to help local patients meet their drug information needs using the Internet, and to perform a preliminary evaluation of this tool.

METHODS

Development--a cross-sectional survey of the drug information needs of local patients using a semi-structured questionnaire; assessment of websites offering free, consumer-orientated medicines information using set criteria; identification of consensus criteria to evaluate the quality of health-related on-line information; evaluation--views on a draft patient information leaflet from a focus group.

RESULTS

Those surveyed felt that being directed to high-quality websites and being provided with assessment criteria for on-line information would be useful. The three websites fulfilling most of the set quality criteria were Surgery Door (www.surgerydoor.co.uk), InteliHealth (www.intelihealth.com) and medlineplus (www.nlm.nih.gov/medlineplus). The six most frequently cited assessment criteria were currency, authorship, commerciality, relevance, links and attribution. A draft leaflet was constructed listing the above three websites and six criteria along with tips on how to search the Internet effectively. A focus group reacted favourably.

CONCLUSION

The Internet is a source of drug information--an information leaflet may help to guide local patients through its variable information quality.

Use of personal digital assistants by adolescents with severe asthma: can they enhance patient outcomes?

Despite the emphasis placed on asthma education, asthma mortality is on the increase, with rates of disability higher in adolescents. Technology provides unprecedented opportunities for developing means to manage, control, and prevent acute episodes in chronic illnesses. This article describes the use of handheld wireless computer devices (eg, personal digital assistant or pocket personal computer) to prevent emergency department visits and to improve outcomes for patients with severe persistent asthma. The uses of personal digital assistants and challenges encountered in their use are described. Recommendations regarding nurses' contribution in the design, implementation, and evaluation of the program patient outcomes are provided.

Internet use by patients with prostate cancer undergoing radiotherapy

OBJECTIVES

To analyze the amount of Internet use, type of Internet use, and factors that predict Internet use by patients with prostate cancer.

METHODS

A questionnaire evaluating the use of the Internet was given to 295 patients undergoing radiotherapy for prostate cancer in three different settings: an academic center (AC), a Veterans Affairs center (VA), and a community hospital. The study included 171 AC patients (58%), 104 VA patients (35%), and 20 community hospital patients (7%).

RESULTS

The response rate to the questionnaire was greater than 99%. Overall, 128 (43%) of 295 patients had a home computer. This differed among the institutions, with 64% of AC patients and only 5% of VA patients having a home computer (P <0.0001). Overall, 94 (32%) of 295 patients used the Internet to access cancer information, with 48% of AC patients and 8% of VA patients using the Internet (P <0.0001). Seventeen percent of black patients (n = 113) had a home computer compared with 62% of white patients (n = 175; P <0.0001). Equal access to computers did not influence Internet use because, among those patients who had access to computers, black patients used the Internet less than did white patients (32% versus 61%, P <0.0001). Men 65 years of age or younger were more likely to use the Internet (45%) than those older than 65 years (28%; P = 0.004). Patients used many sites to access different types of information.

CONCLUSIONS

A significant number of patients with prostate cancer access the Internet to obtain cancer information. Urologists and radiation oncologists should be familiar with this important resource to help patients access appropriate material.

A multi-institutional study of Internet utilization by radiation oncology patients

PURPOSE

Studies describing the use of the Internet by radiation oncology patients are lacking. This multi-institutional study of cancer patients presenting to academic (AC), community (CO), and veterans (VA) radiation oncology centers was designed to analyze the use of the Internet, demographic factors related to utilization, and barriers to access to the Internet.

METHODS AND MATERIALS

A questionnaire evaluating the use of the Internet was administered to 921 consecutive patients presenting to radiation oncology centers at AC, CO, and VA medical centers. The study included 436 AC patients (47%), 284 CO patients (31%), and 201 VA patients (22%). A computer was available at home to 427 patients (46%), and 337 patients (37%) had E-mail access. The mean age of the patient population was 64 (range = 14-93). Males represented 70% of the patient population. The most common diagnoses included prostate cancer (33%), breast cancer (13%), and lung cancer (11%).

RESULTS

Overall, 265/921 patients (29%) were using the Internet to find cancer-related information. The Internet was used by 42% of AC patients, 25% of CO patients, and only 5% of VA patients (p < 0.0001). A computer was available at home in 62% AC vs. 45% CO vs. 12% VA patients (p < 0.0001). Patients < 60 years were much more likely to use the Internet than older patients (p < 0.0001). Most of the Internet users considered the information either very reliable (22%) or somewhat reliable (70%). Unconventional medical therapies were purchased over the Internet by 12% of computer users.

CONCLUSIONS

A significant number of cancer patients seen in radiation oncology departments at academic and community medical centers utilize the Internet to obtain information about cancer. Radiation oncologists must familiarize themselves with this resource because of the large number of patients using the Internet. Veterans lack the computerized access to this information and are thus underserved by this important resource.

Female urinary incontinence health education on the Internet: pitfalls and opportunities

The prevalence and demographics of urinary incontinence (UI) in Canada demand new initiatives to provide both health education and care to the growing number of incontinent women. The Internet, and the Web sites on it, offer an opportunity to provide information on female UI health to patients, health-care professionals, and other caregivers in a time and location convenient to them. Internet usage in Canada is increasing, and women are more likely than men to access Web health information. However, problems such as access to reliable health information do exist, as the quality of Web sites and the information on them varies from excellent to poor. Potential quality control mechanisms include codes of conduct, quality labels, user guides, and filtering systems, but there is uncertainty about which method is best. As the Internet precipitates a shift in care toward prevention of disease, and enhancement of health, a new role for health professionals emerges: to educate patients about and guide them to wise use of the Internet.

The evolution of Web-based medical information on sore throat: a longitudinal study

BACKGROUND

The content of a page can change and is likely to change over time; this is one of the useful qualities of the Web, but also a dangerous one.

OBJECTIVE

To monitor the evolution of Web page contents on sore throat over a 3 year period.

METHODS

Two medical doctors independently evaluated 34 Web pages on sore throat. Pages were found using a metasearch engine. The evaluation factors were: the adherence of medical contents to a gold standard (American Academy of Pediatrics recommendations) composed of 5 subfactors (epidemiological, clinical, complications, diagnosis, and therapy); the completeness of the contents in terms of considered/missed factors of the gold standard; references to medical literature; and a specified last update of the page. During the observation period these sites were revisited twice, after 28 and 39 months, to examine any changes therein since the first visit.

RESULTS

The degree of adherence to the gold standard did not significantly change. Variations (both positive and negative) were recorded solely with regard to the update and references factors as well as with regard to the availability of the pages over time (18% disappeared during the observation period).

CONCLUSIONS

In 3 years medical contents have not changed significantly and despite the contemporary epochal Internet revolution (in terms of, eg, technology, graphics, and access) and the increase in the number of sites dealing with the issue of sore throat, there has been no corresponding qualitative increase in the contents of the pages monitored.

Use of the World Wide Web to implement clinical practice guidelines: a feasibility study

BACKGROUND

Important efforts have been invested in the past few years in the development of quality clinical guidelines. However, the means for the effective dissemination of guidelines to practicing physicians have not been determined. Several studies have examined the possibilities offered by the World Wide Web (the Web), but studies examining the implementation of clinical guidelines in actual practice are clearly lacking.

OBJECTIVE

This study assessed the potential of the Web to implement clinical practice guidelines in actual clinical settings. It also documents the obstacles perceived by the physicians in their use of guidelines on the Internet to determine the role that the Web can play in the implementation of guidelines in practice.

METHODS

Two guidelines were developed using a standardized panel method and made available via the Web. One concerned indications for low-back surgery and the other dealt with indications for upper and lower digestive endoscopies. To identify obstacles to their use in clinical practice, 20 physicians were asked to consult the guidelines during consultations with patients. Answers were collected using 3 different questionnaires.

RESULTS

Questionnaires were completed for consultations involving 213 patients. Less than 50% of the physicians have direct access to the Internet in their examination room. For 75%, the use of the guidelines was easy and the time required to consult them acceptable (3.4 minutes on average, or 12% of the time spent with the patient). The fear that use of such guidelines might interfere with the physician-patient relationship was mentioned as a reason for not consulting the guidelines for 27 consultations. Taking into account their experience with the Web, 75% of the physicians considered that the Web has a great or very-great potential for the dissemination of guidelines and 78% indicated that they would use such guidelines if they became generally available for clinical questions that concerned them. Only 3 physicians had consulted guidelines on the Web prior to this study.

CONCLUSIONS

The acceptance of use of clinical practice guidelines via the Web is high. The main limits to further use of such Web-based guidelines seem to be the lack of a computer connection in the physician's office or examining room and the fear that use of such guidelines might interfere with the physician-patient relationship. Though most participants appreciate the considerable potential of the Web for disseminating guidelines, only a small handful regularly use guidelines available on the Web. There are still numerous obstacles to the regular use of guidelines in clinical practice, some related to the physicians, others to the guidelines themselves.

Use of complementary and alternative medical therapies in patients with cardiovascular disease

BACKGROUND

Complementary and alternative medical (CAM) therapies are becoming increasingly popular, yet little information is available about the prevalence and patterns of CAM therapy use by patients with cardiovascular disease (CVD).

METHODS

Interviewers administered telephone questionnaires to 107 patients randomly selected from a stratified cohort of 2487 eligible patients participating in a registry of patients with CVD.

RESULTS

The current use of CAM therapies was reported by 64% of the patients surveyed. Nutritional supplements (40%) and megadose vitamins (35%) were the most frequently used preparations. Most CAM therapy users (65%) cited their underlying cardiac condition as the reason for taking such therapy. The most common sources of information about CAM were a friend or relative (43%) or the respondent's usual physician. However, although 80% of respondents claimed that they had discussed their use of CAM therapies with their physician, 58% of respondents taking a potentially toxic cardiovascular medication (digoxin, warfarin, sotalol, or amiodarone) were simultaneously taking an oral supplement.

CONCLUSION

The use of CAM therapies was high in the cohort of patients surveyed. Physicians caring for patients with CVD need to inquire about CAM therapy use. Further scientific study should be performed to evaluate the potential benefits and risks of CAM therapies in this patient population.

eHealth in Latin America and the Caribbean: development and policy issues

This paper reviews trends and issues in health and in the information and communication technologies (ICT) market as they relate to the deployment of eHealth solutions in Latin America and the Caribbean. Heretofore designed for industrialized countries and large organizations, eHealth solutions are being proposed as an answer to a variety of health-system management problems and health care demands faced by all health organizations including those in developing societies. Particularly, eHealth is seen as especially useful in the operational support of the new health care models being implemented in many countries. The authors examine those developments vis-à-vis the characteristics of the Latin American and the Caribbean health-sector organizational preparedness and technological infrastructure, and propose policy and organizational actions to foster the development of eHealth solutions in the region.

Virtual connections: Internet health care

Shortly before his death in 1995, Kenneth B. Schwartz, a cancer patient at Massachusetts General Hospital (MGH), founded The Kenneth B. Schwartz Center at MGH. The Schwartz Center is a nonprofit organization dedicated to supporting and advancing compassionate health care delivery that provides hope to the patient, support to caregivers, and encourages the healing process. The Center sponsors the Schwartz Center Rounds, a monthly multidisciplinary forum where caregivers reflect on important psychosocial issues faced by patients, their families, and their caregivers, and gain insight and support from fellow staff members. The 20th century success of the Internet is now translating into changes in 21st century medical practice. The changes brought about by the Internet have at once facilitated and complicated the practice of medicine. Physicians and patients are challenged to take advantage of the increased opportunities afforded by Internet access while being mindful of its drawbacks and the limitations to virtual communication. The case of Karen Parles, one of the authors, is presented. Karen developed locally advanced lung cancer and used the Internet to research her diagnosis. She found the information on lung cancer limited and confusing, and, in response, developed a website devoted to empowering lung cancer patients in their search for information and support (http://www.lungcanceronline.org). Here we discuss issues surrounding patients' use of the Internet for health information and communication with health care providers. The value of information-seeking as a coping mechanism is debated, and concerns are raised regarding confidentiality of electronic communications and the logistics of physicians adopting e-mail as a mechanism for communicating with patients.

Vaccine and immunization resources on the World Wide Web

Abundant information regarding immunizations and vaccines is available on the World Wide Web. This report was prepared as a guide to reliable Internet sources for health care providers, researchers, and patients or parents interested in gaining Web-based information on these topics. I describe comprehensive Web sites about immunizations, meetings on immunizations, and clinical trials on vaccines and for journals and publications on vaccines, organizations providing immunization information, and pharmaceutical companies and vaccine manufacturers.

A survey of the quality of web based information on the treatment of schizophrenia and Attention Deficit Hyperactivity Disorder

OBJECTIVE

To systematically assess the quality, accountability and readability of Internet information on the treatment of schizophrenia and Attention Deficit Hyperactivity Disorder (ADHD), using a standardized pro forma.

METHOD

We analysed the 20 most highly ranked pages on the treatment of ADHD and schizophrenia, identified by five common Internet search engines.

RESULTS

There was little overlap in the sites identified by different search engines. In the case of schizophrenia, one site was identified three times and another eight sites twice; while for ADHD four sites were identified twice. Accountability (Silberg score), presentation and readability, as assessed by the Flesch-Kincaid Grade Level score, were poor. Mean Silberg, presentation and Flesch-Kincaid Grade Level scores were 3.2 (range 0-9) out of 9, 1.9 (range 0-4) out of 4, and 11.5 (range 6.5-12.25), respectively. There was no statistical difference in scores between the two diagnoses. Depending on the recommendation, agreement with evidence-based practice for schizophrenia ranged from only 2 to 55% (mean = 2.8 (range 0-9) out of 12), while that for ADHD was from 14 to 54% (mean = 1.6 (range 0-6) out of 6). Only 50% of the sites advised readers to clarify information with an appropriate health professional. Interrater reliability in pro forma scores for schizophrenia and ADHD was high (r = 0.96 and 0.95, respectively, p < 0.0001). Sites in the top 10% of scores were significantly more likely to be owned by an organization or have an editorial board than those in the bottom 10%.

CONCLUSIONS

The Internet contains misleading information on both schizophrenia and ADHD. The methodology used in this paper could be adapted for other psychiatric conditions.

The relationship of race to women's use of health information resources

OBJECTIVE

The purpose of this study was to examine, among the general public, the independent effect of race on women's use of health information resources.

STUDY DESIGN

A population-based random-digit dialing survey of adult women, aged 18 to 64 years, was conducted between October 1999 and January 2000. Subjects included 509 women (341 white women, 135 black women, and 33 women of other races). The response rate was 66%. The main outcome variable was the use of health information resources (print health or news media, broadcast media, computer resources [Internet], health organizations, organized health events). Logistic regression was used to determine the independent effect of race/ethnicity on the use of different information resources, with an adjustment for age, income, education, and marital status.

RESULTS

After the adjustment for socioeconomic factors, black women had <50% odds of using print news media (odds ratio, 0.5; 95% CI, 0.4-0.8), <60% odds of using computer-based resources (odds ratio, 0.4; 95% CI, 0.2-0.6), and <70% odds of using health policy organizations (odds ratio, 0.3; 95% CI, 0.2-0.7), compared with white women.

CONCLUSION

There is a large racial disparity in women's use of health information resources. Traditional sources that are used to provide patient information may not be effective in certain populations.

Internet use by a multidisciplinary transplant clinic population

BACKGROUND

This study was designed to determine patterns of patient Internet use and to define socioeconomic and other barriers that affect such use.

METHODS

A 44-item questionnaire was distributed to patients seen in the transplant clinic during April 2001.

RESULTS

A total of 170 patients completed the questionnaire. Fifty-six percent had access to the web. Seventy-two (42%) were African American, and 85 (50%) were Caucasian. Internet use was higher among Caucasian patients, but education level had the strongest correlation. Seventy-three percent of patients with a college education had Internet access compared with 38% of patients with a high school diploma. Twenty-two percent of patients used the Internet to find information about their doctor, and 35% searched for transplant survival results.

CONCLUSIONS

Patients use the Internet to find information about their doctors and results of transplantation and other treatments. Physicians should consider establishing guidelines for use of Internet services by patients for education and communication.

The use of computer telephony to provide interactive health information

The use of information technology to provide health information to the public has grown at a rapid pace. Numerous sources of health care information within both the print and Internet media are now available. Yet, their availability raises concerns about the quality of the information provided and questions about which is the most effective method for transmitting health information to consumers. We present an interactive method of presenting high-quality health information that uses a new approach: an integration of the telephone and the computer also called computer telephony. Telephone-Linked Communication for Health Information (TLC-HI) is a computer-based telecommunications system that functions as an educator to people in search of answers to health-related issues. To create TLC-HI, we converted validated print-based consumer information into computer-controlled conversational dialogues. We discuss the potential that the TLC-HI approach holds for improving the way health information is communicated.

Health-related Internet use, coping, social support, and health indicators in people living with HIV/AIDS: preliminary results from a community survey

Widespread Internet use has revolutionized health information and patient education for persons with chronic illnesses. The authors surveyed 147 HIV-positive persons to examine factors associated with Internet use and associations between Internet use and health. Information, motivation, and behavioral skills associated with using the Internet were related to Internet use. The authors found that health-related Internet use was associated with HIV disease knowledge, active coping, information seeking coping, and social support among persons who were using the Internet. These preliminary findings suggest an association between using the Internet for health-related information and health benefits among people living with HIV/AIDS, supporting the development of interventions to close the digital divide in HIV/AIDS care.

Improving the quality of decision making in breast cancer: consultation planning template and consultation recording template

PURPOSE/OBJECTIVES

To describe two templates that can be used to improve the quality of breast cancer treatment decisions.

DATA SOURCES

Case study, survey of current users, three clinical trials.

FINDINGS

Clinical applications of the Consultation Planning Template and Consultation Recording Template vary across organizations. Clinical trials have demonstrated that the templates can improve the quality of decisions, the quality of communication between patients and providers, and satisfaction.

CONCLUSIONS

The templates can be adapted to different clinical settings and can improve the quality of treatment decisions.

IMPLICATIONS FOR NURSING

Nurses often provide the majority of education and coaching for patients making decisions. As patients' demands for involvement in decision making increase, nurses need practical tools to help patients participate. The templates are practical tools that nurses can use to help patients make better decisions.

Sources of cancer information for seniors: a focus group pilot study report

BACKGROUND

Limited research has been conducted on older adults' sources of cancer information. Seniors require accurate and credible cancer information given that increased age is a major risk factor for most common, adult-onset cancers.

METHODS

To examine older women's sources of cancer information and their views on cancer as portrayed in mass print publications, three pilot focus groups were conducted in Toronto, Canada with community-dwelling senior women aged 50 and over (n = 18).

RESULTS

Results showed that the majority of participants obtained their cancer facts from two primary sources: physicians and the print media, although both sources were perceived to provide inadequate and unclear information. Medical journalists were rated as scientifically untrained members of the media who provided conflicting health information to the public. Cancer information was regarded as credible by participants if it came from authoritative sources including notable journals, government agencies, or health organizations.

CONCLUSIONS

These findings reflect senior women's concerns with cancer research information being disseminated through the media. To facilitate cancer prevention and early detection behaviors, it is important that the media impart accurate and understandable cancer information to our aging population.

[Measurement of the legibility of written texts. Correlation between the Flesch manual method and computer methods]

OBJECTIVE

To compare, for the calculation of the Flesch legibility index, the original manual method and the computer programmes Word Perfect 7 and Microsoft Word 2000; and to correlate these with other computer measurements of legibility.

DESIGN

Descriptive, observation study.

SETTING

A Madrid Health Centre, within a study of the legibility of health education (HE) leaflets.

MATERIAL

A sample of text from 100 HE leaflets and 11 general control texts. Main measurements. The 11 texts were analysed through Flesch' s original manual method and the computer programmes mentioned, with which the number of words and sentences, the Flesch scores, the index of sentence complexity and the LEGIN index were calculated. Pearson's correlation coefficient was calculated for all the variables.

RESULTS

There was very good correlation between the manual measurement of the Flesch index, the number of words and sentences, and their determination by means of computers (r>0.75); and excellent correlation between the two programmes (r>0.9). The results support the cut-off scores in other studies for legibility measured by computer.

CONCLUSIONS

Measurement of legibility through the computer programmes used can reliably replace manual measurement of the Flesch index.

[Evaluation of Spanish websites useful for the primary care physicians]

OBJECTIVE

To assess the usefulness of medical websites in spanish for the primary care physicians using quality criteria chosen by themselves.

DESIGN

Observational, descriptive, cross-sectional study.

SETTING

Internet.

PARTICIPANTS

The search was performed in Google and Yahoo using as key words the name of Spanish National Health Service medical specialities, primary care and synonyms. The first one hundred links in spanish for every keyword were included in the study.

EXCLUSION CRITERIA

paysites, commercial sites, non-clinical content, link sites, patient oriented sites and on-line editions of printed issues.

METHODS

A survey was carried out asking the primary care physicians of area IV in Asturias which were the most important criteria that a medical website should fulfil. The results of this survey were used to make an assessment questionnaire. Every site was analysed randomizedly by two researchers and was classified as excelent, good, medium or bad.

RESULTS

2.095 medical websites in spanish were found, being repeated 1.218 (58.14%). From the 877 analysed websites, 597 (68.07%) were excluded. The Intraclass Correlation Coefficient (ICC) was 0.73 (95% CI, 0.66%-0.785%). 5 websites (1.8%) were rated as excelent and the 77.2% as medium or bad. The sites with better ratings were those oriented to the primary care professionals.

CONCLUSIONS

The most websites were rated as medium or bad. The evaluation questionnaire is useful for futures studies.

Unmet needs of primary care patients in using the Internet for health-related activities

BACKGROUND

Millions of people use the Internet as a source for health information yet little is understood about the use of the Internet for other health-related activities.

OBJECTIVE

We conducted the present study to understand, among primary care patients, the interest in and experience with using the Internet for a variety of health-related activities.

METHODS

Cross-sectional survey in the setting of 4 community-based primary care practices in Rhode Island. A single self-administered questionnaire included the following: 14 items measuring interest in using the Internet for a variety of health-related purposes, demographics, self-reported health status, and self-reported health care quality.

RESULTS

The survey was completed by 300 patients, 109 without access to the Internet and 191 with access to the Internet. Experiences with and attitudes about each of the health-related activities on the Internet varied widely across each activity. Regardless of access, patients were most interested in using the Internet for finding information about diseases and medications. However, patients with Internet access were more interested, compared to those without access, in each of the health-related activities on the Internet. Among patients with access to the Internet, the largest gap between interest and experience (the opportunity gap) was in using the Internet to investigate the quality of their care (eg, "find out if your health care provider was giving you all of the tests and treatments that you are due to have?") and administrative functions (eg, "schedule an appointment with your doctor?").

CONCLUSIONS

Much opportunity remains for developing health-related Internet Web sites to address the unmet needs of primary care patients.

Evaluation of accessibility and use of new communication technologies in patients with type 1 diabetes mellitus

BACKGROUND

The role of patients in the management and control of type 1 diabetes mellitus, a chronic disease, is well established. The advent of new communication technologies is expected to improve patients' access to health information. However, little is known about the extent to which patients with type 1 diabetes mellitus use the Internet to retrieve medical information and about the impact, if any, this retrieval has on their health status.

OBJECTIVE

To evaluate the accessibility and use of new communication technologies in a population of patients with type 1 diabetes mellitus.

METHODS

Patients with type 1 diabetes mellitus attending the Diabetes Clinic of the Hospital de Sabadell, Sabadell, Spain, in a 6-month period were asked to answer a structured questionnaire about education level, Internet accessibility, use of health-related Web sites, and mobile-phone ownership and use.

RESULTS

Of 302 patients with type 1 diabetes mellitus attending the Diabetes Clinic on a regular basis, 244 (115 men, 129 women) were interviewed (response rate 80.8%). Personal computers were owned by 58.2% of patients. Fifty-nine percent had access to the Internet, 39.3% had access to the Internet at home; however, only 36.5% were regular Internet users. Internet users were younger, more frequently men, and of higher education level. Among Internet users only 49.4% had ever accessed a health-related Web site. Internet users who had ever accessed a health-related Web site had a higher level of education, presented severe hypoglycemia more frequently, and were more likely to have access to the Internet at home. No differences were found in metabolic control between Internet users and nonusers or between Internet users who had ever accessed a health-related Web site and Internet users who had never accessed a health-related Web site. Of the 76.6% of the patients that owned a mobile phone, 96% used it more than once a week.

CONCLUSIONS

The impact of new communication technologies might be jeopardized by the low rate of access and utilization of the Internet for health-related purposes. Because of their high rate of ownership and use, mobile phones show promise as a tool in health care communication technologies.

Health care web sites: are they reliable?

Locating reliable health care information on the World Wide Web is difficult and confusing. Thus, Internet users must choose the appropriate resources to guide their health care decisions. This paper will describe the "typical" Internet user. Then, it will compare the three most "comprehensive" web site guidelines. Finally, it will summarize what criteria are necessary to create and maintain reliable health care web sites.

The internet

The growing use of email and the world wide web (WWW), by the public, academics, and clinicians-as well as the increasing availability of high quality information on the WWW-make a working knowledge of the internet important. Although this article aims to enhance readers' existing use of the internet and medical resources on the WWW, it is also intelligible to someone unfamiliar with the internet. A web browser is one of the central pieces of software in modern computing: it is a window on the WWW, file transfer protocol sites, networked newsgroups, and your own computer's files. Effective use of the internet for professional purposes requires an understanding of the best strategies to search the WWW and the mechanisms for ensuring secure data transfer, as well as a compendium of online resources including journals, textbooks, medical portals, and sites providing high quality patient information. This article summarises these resources, available to incorporate into your web browser as downloadable "Favorites" or "Bookmarks" from www.jnnp.com, where there are also freely accessible hypertext links to the recommended sites.

Health benefits and risks of the Internet

The linking of the Internet with health and medicine involves all levels of society, including individuals, health care providers, professional organizations, communities, and local and federal governments. A growing body of evidence suggests that despite the benefits of the Internet, this means of communication also figures into the creation of new forms of health risk for some users. This paper examines the effects of the Internet on the promotion of both health and illness. The discussion focuses on those factors of online communication that produce positive health outcomes and also the potential for health risk. Implications for health providers and for better serving patients are analyzed together with recommendations for improving services for those who go online to access health information.

Direct marketing of pharmaceuticals to consumers

Revised FDA regulations governing pharmaceutical companies' broadcast advertisements directed to consumers produced substantial increases in direct-to-consumer advertising (DTCA) expenditures. Proponents of DTCA claim it supports patient autonomy in the patient-physician relationship and has motivated some consumers to seek a physician's care for conditions they previously had not discussed with a doctor. However, DTCA's blend of promotion and information has produced more prescription drug awareness than knowledge--it has been largely ineffective in educating patients with medical conditions about the medications for those conditions. The evidence for DTCA's increase in pharmaceutical sales is as impressive as is the lack of evidence concerning its impact on the health of the public. Broadcast advertisements are too brief to include extensive technical information; consequently, the impact of FDA regulations to assure a fair balance of risk and benefit in DTCA is still being assessed.

Users of Internet health information: differences by health status

BACKGROUND

Millions of consumers have accessed health information online. However, little is known about their health status.

OBJECTIVE

To explore use of Internet health information among those who were sicker (fair/poor general health status) compared with those reported being healthier.

METHODS

A national, random-digit telephone survey by the Pew Internet & American Life Project identified 521 Internet users who go online for health care information. Our primary independent variable was general health status rated as excellent, good, fair, or poor. Patterns of Internet use, and types of information searched were assessed.

RESULTS

Among the 521 users, 64% were female, most (87%) were white, and median age was 42 years. Most individuals indicated that they learned something new online (81%) and indicated that they believe most information on the Internet (52%). Compared with those with excellent/good health, those with fair/poor health (N = 59) were relative newcomers to the Internet but tended to use the Internet more frequently, were more likely to use online chats, were less likely to search for someone other than themselves, and were more likely to talk about the new information with their physician (odds ratio 3.3 [95% confidence interval 1.8-6.3]), after adjustment for age, education and income.

CONCLUSIONS

Health care professionals should be aware that their sicker patients are more likely to ask them about information they found online. Physicians, public health professionals, and eHealth developers should work together to educate patients about searching for health information online and to provide tools for them to navigate to the highest quality information.

Evaluation of plastic surgery information on the Internet

The Internet allows vast access to medical information. Unlike most plastic surgery literature, the Internet is a quagmire of unfiltered information, not subject to peer review. To assess the accuracy of medical information on the Internet the authors studied one commonly performed elective procedure, classifying and defining the information retrieved. Using the keyword "breast augmentation," the authors compiled a list of the first 300 web sites, obtained from six distinct search engines, yielding 215 unique sites. They devised an instrument to evaluate each site for its accessibility, relevance, and accuracy. Of the 215 unique web sites evaluated, 20 were inaccessible, 24 were irrelevant, and 41 contained no medical information. Of the remaining 130 sites, almost 34% contained false or misleading information. Errors pertained most often to the technical details of the operation, potential benefits, and risks. In addition, exaggerated claims concerning alternative breast enhancement regimens, adverse sequelae of silicone breast implants, and potential effects on lactation were also seen commonly. A considerable amount of information regarding breast augmentation on the Internet was either misleading or inaccurate. Physicians can assist their patients with specific guidelines to allow them to process information discerningly, thereby diminishing the likelihood that medical decisions are based on misinformation.

Consumer Health Informatics--integrating patients, providers, and professionals online

Consumer Health Informatics (CHI) means different things to patients, health professionals, and health care systems. A broader perspective on this new and rapidly developing field will enable us to understand and better apply its advances. This article provides an overview of CHI discussing its evolution and driving forces, along with advanced applications such as Personal Health Records, Internet transmission of personal health data, clinical e-mail, online pharmacies, and shared decision-making tools. Consumer Health Informatics will become integrated with medical care, electronic medical records, and patient education to impact the whole process and business of health care.