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ONLINE HEALTH INFORMATION Patient and Physician Utilization of the Internet as a Medical Resource

ONLINE HEALTH INFORMATION Patient and Physician Utilization of the Internet as a Medical Resource. Jason Mitchell April 19, 2012. ONLINE HEALTH INFORMATION Patient and Physician Utilization of the Internet as a Medical Resource. Jason Mitchell, PGY-3 April 19, 2012. PATIENT DEMOGRAPHICS.

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ONLINE HEALTH INFORMATION Patient and Physician Utilization of the Internet as a Medical Resource

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  1. ONLINE HEALTH INFORMATIONPatient and Physician Utilization of the Internet as a Medical Resource Jason Mitchell April 19, 2012

  2. ONLINE HEALTH INFORMATIONPatient and Physician Utilization of the Internet as a Medical Resource Jason Mitchell, PGY-3 April 19, 2012

  3. PATIENT DEMOGRAPHICS • 78% of American adults use the internet • 59% of all adults look for OHI • 80% of internet users search online for health information • 94% of internet users check email • 87% of those going online use a search engine Pew American Internet and Life Project 2010

  4. PATIENT DEMOGRAPHICS • More likely to search for OHI • Ages 18-49 • Female • Caucasian • Higher education • Higher income

  5. PATIENT DEMOGRAPHICS • 40-50% of patients discuss OHI with their doctors • 11% used the internet instead of doctors • More convenient • Less expensive • Physician not open to discussion • Mistrust • Not enough time with physician Diaz J. J Gen Intern Med 2002

  6. PATIENT DEMOGRAPHICS A) Sources where patients would prefer to obtain health information B) Sources where patients actually went to for health information Hesse B. Arch Intern Med. 2005

  7. ED PATIENT DEMOGRAPHICS 37% Pourmand A. West J Emerg Med. 2011

  8. ED PATIENT DEMOGRAPHICS 15% Pourmand A. West J Emerg Med. 2011

  9. PATIENT SEARCH QUERIES • Statistics Canada, 2005 • N = 30, 466 • 60% of internet users search for OHI

  10. PHYSICIAN DEMOGRAPHICS • 86-89% of physicians use the internet for OHI

  11. PHYSICIAN DEMOGRAPHICS • 86-89% of physicians use the internet for OHI

  12. PHYSICIAN SEARCH QUERIES Parekh N. 2009

  13. PHYSICIAN SEARCH QUERIES Parekh N. 2009

  14. OHI AS A PHYSICIAN AID • 2006 Study • NEJM Cases • 3-5 search terms • Entered into Google • Diagnostic Accuracy 58% • (15 of 26 cases) Tang H. BMJ. 2006

  15. OHI AS A PHYSICIAN AID • 2011 Study • EM Residents • N = 33, PGY 1-3 • Pre-test and Google Post-Test

  16. OHI AS A PHYSICIAN AID Pre-Test GoogleTest Krause R. West J Emerg Med. 2011.

  17. SEARCH STRATEGIES • How do patients search for online health information? Eysenbach G. BMJ. 2002.

  18. SEARCH RESULTS • 2009 Study • Titles of all MEDLINEplus Health Encyclopedia, NHS Direct Online, and NORD articles entered into Google • Index of top 10 websites offered • Wikipedia was significantly in the top 10 • 74.5% of all search terms • Medscape 44.4% • Mayo Clinic 31.6% • eMedicine 22.7% • Merck 9.3% Laurent M. J Am Med Inform Assoc. 2009.

  19. ED CARDINAL PRESENTATIONS

  20. ED CARDINAL PRESENTATIONS

  21. QUALITY • ACCURATE • COMPLETE • UNDERSTANDABLE

  22. Giles J. Nature. 2005.

  23. WIKIPEDIA ON DRUGS • 2008 Study Comparing Wiki entries to MDR • Wikipedia less able to provide answers (40.0% vs 82.5%, p<0.001) • Higher errors of omission (48 vs 14) • Wikipedia did not provide dosing info (0% vs. 90%) • Wikipedia entries less complete (76% vs. 95.5%, p<0.001) • No factual errors, 4 in MDR Clauson K. Ann Pharmacother. 2008.

  24. WIKIPEDIA ON DRUGS • 2011 Study Comparing Wikipedia to LexiComp • 5 statins reviewed • 4 of 5 articles deemed less complete than LexiComp • Missing or incomplete list • Adverse Effects • Contraindications • Drug Interactions Kupferberg N. J Med Libr Assoc. 2011.

  25. WIKIPEDIA ON SURGERY • 2007 Study • Identified 35 of 39 most common surgeries in Wikipedia • 100% presented accurate content • 37.1% contained critical omissions • Significantly few articles discussed surgical risks Devgan L. J Am Coll Surg. 2007.

  26. WIKIPEDIA ON CANCER • 2011 Study Comparing Wikipedia to PDQ Malolan S. J Oncol Pract. 2011.

  27. WIKIPEDIA ON MENTAL DISORDERS • 2011 Study Schizophrenia Depression Reavley N. Psychol Med. 2011.

  28. WIKIPEDIA • Studies suggest Wikipedia • Has comparable accuracy • Encyclopedias • Other medical resources • Expert opinion • Is incomplete • May be difficult to comprehend

  29. OTHER SOURCES • 2002 Systematic Review of MEDLINE, EMBASE, PubMed and other sources • 7830 citations assessing OHI screened, 79 included • 70% of included studies felt that quality is a problem • Average 35.3% of Web sites inaccurate • Compared to literature, textbooks, or expert opinion • 38.3% inaccurate compared to clinical practice guidelines • Majority of sites written at a Grade 12 comprehension level • High heterogeneity Eysenbach G. JAMA. 2002.

  30. EMERGENCY MEDICINE OHI • 2004 Study • Compared EM OHI to checklists created from ‘gold standards’ • Evaluated • MI • Stroke • Febrile child • Influenza • Searched the 12 most frequented sites • MayoClinic, MEDLINEplus, Medscape, WebMD, Yahoo!Health Zun L. Am J Emerg Med. 2004.

  31. EMERGENCY MEDICINE OHI • 0% of websites contained complete medical information • MEDLINEplus most complete: 83% • MayoClinic.com and Medscape had greater than 50% • Majority of the websites fell between 35 and 50% • 5 instances of inaccurate information • Defined fever as both 37oC and 1oF above 98.6oF (37.6oC) • Advised taking a cold bath if stroke symptoms occurred

  32. EMERGENCY MEDICINE OHI • Revised 2011 • MSN Health and Yahoo!Health scored the highest • Higher than MayoClinic, WebMD, NIH.gov • Majority of websites > 50% • No evaluated sites inaccurate • Median reading level Grade 9 Zun L. West J Emerg Med. 2011.

  33. IS OHI HARMFUL? • Limited evidence to suggest harmful • Potential for: • Patients believing a condition is treatable when it is not • Patients following misleading advice • Patients making self-diagnoses that are incorrect • Initiating medical treatment that may be hazardous

  34. IS OHI HARMFUL? • 2002 Systematic Review • 1512 Articles screened, 186 reviewed • 3 identified cases • 2 cases of emotional distress • 1 case of physical harm • 2% patients report knowing someone harmed by OHI Crocco AG. JAMA. 2002.

  35. JUDGMENT OF CREDIBILITY • Most patients believe online health information is trustworthy • 72% believe all or most information • Confusion = Credibility? • 2004 Study: Up to 60% unable to find answers • Majority of respondents satisfied with the answers they found • 60% rated online information equal to or better than their doctors Zeng Q. Int J Med Inform. 2004.

  36. THE PHYSICIAN ENCOUNTER • 50% bring up OHI in the context of the physician encounter • Most only want the physician’s opinion • As opposed to requesting specific tests/treatments • Majority of patients felt OHI in the medical encounter had beneficial impact on their care • Trust remains high

  37. THE PHYSICIAN ENCOUNTER Patterns of trust for sources of health information 2002-2008 Hesse BW. NEJM. 2010.

  38. THE PHYSICIAN ENCOUNTER • Negative impact on the patient-physician relationship • 4% report negative interactions with the physician • Physician dismissive, poorly communicative, threatened • 12% search for second opinion Murray E. Arch Intern Med. 2003.

  39. CONCLUSION • The internet as a medical resource is commonplace • Quality of OHI mixed with room for misinterpretation • Patients seek collaboration with physicians

  40. WHAT CAN WE DO? • Don’t dismiss the web-savvy patient • Emphasize interpretation of OHI within the context of the physician encounter • Identify and offer credible websites • Peer-reviewed, written by experts, medically sponsored • WebMD, Medscape, MEDLINEplus, HealthCanada • Contribute to the wealth of OHI

  41. QUESTIONS?

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