Transcript patient demographics - Calgary Emergency Medicine

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
 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
PATIENT DEMOGRAPHICS
• More likely to search for OHI
• Ages 18-49
• Female
• Caucasian
• Higher education
• Higher income
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
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
ED PATIENT DEMOGRAPHICS
37%
Pourmand A. West J Emerg Med. 2011
ED PATIENT DEMOGRAPHICS
15%
Pourmand A. West J Emerg Med. 2011
PATIENT SEARCH QUERIES
• Statistics Canada,
2005
• N = 30, 466
• 60% of internet
users search for OHI
PHYSICIAN DEMOGRAPHICS
 86-89% of physicians use the internet for OHI
PHYSICIAN DEMOGRAPHICS
 86-89% of physicians use the internet for OHI
PHYSICIAN SEARCH QUERIES
Specific Drug Information
77%
General Condition Information
75%
Drug Safety Information
66%
Information For Patients
61%
Information to Aid Diagnosis
53%
Parekh N. 2009
PHYSICIAN SEARCH QUERIES
Specific Drug Information
77%
General Condition Information
75%
Drug Safety Information
66%
Information For Patients
61%
Information to Aid Diagnosis
53%
Parekh N. 2009
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
OHI AS A PHYSICIAN AID
 2011 Study
 EM Residents
 N = 33, PGY 1-3
 Pre-test and Google Post-Test
OHI AS A PHYSICIAN AID
Pre-Test
GoogleTest
Krause R. West J Emerg Med. 2011.
SEARCH STRATEGIES
 How do patients search for online health information?
Eysenbach G. BMJ. 2002.
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.
ED CARDINAL PRESENTATIONS
FEVER
WEAKNESS
VERTIGO
CONFUSION
RED AND PAINFUL EYE
COMA
SEIZURES
HEADACHE
DYSPNEA
CHEST PAIN
SYNCOPE
NAUSEA/VOMITING
ABDOMINAL PAIN
GASTROINTESTINAL BLEEDING
DIARRHEA
CONSTIPATION
JAUNDICE
PELVIC PAIN
VAGINAL BLEEDING
BACK PAIN
CYANOSIS
SORE THROAT
HEMOPTYSIS
ED CARDINAL PRESENTATIONS
FEVER
WEAKNESS
VERTIGO
CONFUSION
RED AND PAINFUL EYE
COMA
SEIZURES
HEADACHE
DYSPNEA
CHEST PAIN
SYNCOPE
NAUSEA/VOMITING
ABDOMINAL PAIN
GASTROINTESTINAL BLEEDING
DIARRHEA
CONSTIPATION
JAUNDICE
PELVIC PAIN
VAGINAL BLEEDING
BACK PAIN
CYANOSIS
SORE THROAT
HEMOPTYSIS
QUALITY
 ACCURATE
 COMPLETE
 UNDERSTANDABLE
Giles J. Nature. 2005.
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.
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.
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.
WIKIPEDIA ON CANCER
 2011 Study Comparing Wikipedia to PDQ
Malolan S. J Oncol Pract. 2011.
WIKIPEDIA ON MENTAL DISORDERS
 2011 Study
Schizophrenia
Depression
Reavley N. Psychol Med. 2011.
WIKIPEDIA
 Studies suggest Wikipedia
 Has comparable accuracy
 Encyclopedias
 Other medical resources
 Expert opinion
 Is incomplete
 May be difficult to comprehend
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.
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.
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
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.
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
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.
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.
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
THE PHYSICIAN ENCOUNTER
Patterns of trust for sources
of health information 20022008
Hesse BW. NEJM. 2010.
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.
CONCLUSION
 The internet as a medical resource is commonplace
 Quality of OHI mixed with room for misinterpretation
 Patients seek collaboration with physicians
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
QUESTIONS?