The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #68370

Roe Ann Roberts, PhD MPH, Health and Public Administration Programs, Midwestern State University, 3410 Taft Blvd, Wichita Falls, TX 76308, (940) 397-4752, roe.roberts@mwsu.edu

In the 1980's, developing informed educated patients was viewed as a way to control costs and improve the quality of care (Gibson, 2003). Patient education approaches were physician-driven, physicians provided patients with select information and trained them to perform certain select technical activities. However, a newer, less physician controlled approach, "self-management", may be a more effective way to improve clinical outcomes and reduce costs. Self-managed patients develop problem-solving skills along with the confidence to reach a desired goal (Bodenheimer, 2002). The Internet may promote the development of self-managed patients as it gives individuals a way to search out health-related information, but it also poses problems. First, how reliable is that information? Attempts to answer this question have produced questionable results (Craigie, 2002). Secondly, physician responses to Internet derived information may negatively affect patient-doctor relationships. This study reviewed discussions on a chronic disease listserv (N=92). It found reports of doctors who discouraged patients from using the Internet and/or who refused to discuss health related research patients found on the Internet. This behavior raised real concerns for these individuals, did their doctor only value quiet, compliant patients who did what they were told? Unbeknownst to these doctors their responses negatively impacted their relationships with these patients. Another concern is will other listserv members generalize the negative responses of a few doctors to all doctors shutting down communication lines with their own doctors? The Internet is here to stay. In 2002, 110 million individuals were accessing it (Taylor). Unfortunately some patients may be more computer literate and better able to access new, cutting edge treatments and research than their physicians. Sastry (2002) reported physicians had limited Internet access and often found it difficult to answer specific medical questions using Internet search engines. A clinic survey found 54% of patients used the Internet to research medical information. 60% felt the information was the "same as" or "better than" what their doctors gave them, but 59% didn't discuss what they found with their doctors (Diaz, 2002). A larger study, found 61% of Internet users didn't discuss information they found with their physicians. Yet, 82% thought the information was of 'good quality' and almost 24% used it to make decisions about their health behaviors (Taylor, 2002). As more patients access the Internet, physicians must be willing to discuss the information their patients find with them or the damage to physician-patient relationships will hamper quality improvement efforts.

Learning Objectives:

• Describe the 'self-managed' patient model and its cost and quality improvement benefits.
• Recognize the potential impacts of the Internet on self-management.
• List and discuss the benefits and negatives of some commonly used Internet health care information sites.
• Discuss three types of patients who utilized healthcare related information gleaned from the Internet.
• Assess the potential impacts, positive and negative, of Internet information on the patient-physician relationship.

Keywords: Self-Management, Internet

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.