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PubMed2000

[Nine out of ten Norwegian physicians have access to the Internet].

BACKGROUND: Access to the Internet increases rapidly among physicians as well as in the general populations. We have monitored Norwegian physicians' use of the Internet over several years. MATERIALS AND METHOD: During the spring of 2000, 1,318 out of 1,589 (83%) Norwegian physicians answered a questionnaire which included several questions on their use of the Internet. RESULTS: Nine out of ten Norwegian physicians have Internet access and one out of four finds the Net useful or very useful in keeping professionally updated or in their daily work. Half of the physicians read e-mail several times per week, but only one out of ten receive e-mail from patients, most of them only occasionally. Physicians' access to the Internet has increased from 38% to 90% since 1997, particularly access from home. Two out of three general practitioners only have access to the Internet from home. Physicians with Internet access both from home and from work use the net more frequently for professional purposes than others and report a higher degree of usefulness of the Internet. INTERPRETATION: The Internet is now an integrated part of physicians' daily life. Electronic communication between doctors and patients is, however, still infrequent and there may be a potential for improved doctor-patient-communication over the Internet.

Adult↗

PubMed2002

Relationships among Internet health information use, patient behavior and self efficacy in newly diagnosed cancer patients who contact the National Cancer Institute's NCI Atlantic Region Cancer Information Service (CIS).

This NCI funded study examined the relationship between the use of Internet health information by people newly diagnosed with cancer (N=500), with patient task behavior and perceived self efficacy. Study variables were compared among Direct users of Internet health information (people using the Internet themselves), Indirect users of Internet health information (people receiving Internet health information from friends or family members), and Non-users of Internet health information (people not using the Internet or receiving health information from the Internet). The subjects were recruited from persons who called the Atlantic Region of the NCI's Cancer Information Service (CIS), located at Fox Chase Cancer Center in Philadelphia, PA. Follow up phone interviews were done with participants six weeks after initial contact to assess impact of the use of the Internet on perceived patient task behavior and self efficacy. Results show significant relationships between Internet use and all study variables.

Health Education↗

PubMed2004

Internet use by colorectal surgery patients: a surgeon's tool for education and marketing.

The goal of this study is to understand the role of the Internet in the education and recruitment of patients within colorectal surgery practices. Surveys of Internet use were completed by 298 patients visiting five outpatient colorectal surgery clinics affiliated with the University of Southern California. Data collected included the patient's age, gender, level of education, zip code at home, type of clinic visited, and information on the respondent's Internet use. Overall, 20 per cent of the respondent patients visiting our clinics had used the Internet to research the medical condition that prompted their visit. Highest grade level completed (P < 0.001), age (P < 0.01), type of clinic (P < 0.001), and household income (P < 0.001) were all found to be associated with any prior use of the Internet whereas gender was not (P = 0.58). Among Internet users, only household income and frequent use of the Internet were associated with searching the Internet for medical information (P < 0.001). Ultimately, all of the Internet-using patients surveyed felt the medical information they found was "some what" or "very helpful." Understanding which patients "go online" to search for medical information is essential for surgeons who wish to use the Internet for marketing their practices and educating their patients.

Chi-Square Distribution↗

PubMed2004

Assessment of disease severity (in terms of function) using the internet.

OBJECTIVE: To determine whether visual analog scales (VAS) can be used over the Internet to assess the patient with ankylosing spondylitis (AS) accurately or if the use of this different medium will affect the results. METHODS: Patients with AS (n = 50) attending a physiotherapy/educational course completed both an Internet based and a paper based version of the Bath Ankylosing Spondylitis Functional Index (BASFI) that uses VAS. The Internet version was completed twice to assess intrarespondent variation reliability and compared with the paper version to assess interrespondent variation reliability. Patients were also asked to assess ease of use and to suggest changes to the Internet version. RESULTS: The interclass coefficient of intra- and interrespondent reliability were 0.989 (p < 0.001) and 0.976 (p < 0.001), respectively. There was a 3% difference in assessments carried out over the Internet compared to those on paper and a 2% difference in repeatability of Internet assessed questionnaires. Bland and Altman plots showed a mean difference between paper compared to the Internet version was 0.0156 with 95% limits of agreement at -1.07 to 1.03. More than half the participants reported that the Internet version was easier to complete than the paper version (96% rated usability as 1 on a scale of 1-10, with 1 being extremely easy and 10 being impossible). CONCLUSION: Assessment of disease severity by VAS may be accurately carried out over the Internet. This means that the evaluation of disease status and the longterm followup of people in different countries and perhaps in different languages may now be possible, using the Internet.

Adult↗

PubMed2004

Are Spanish physicians ready to take advantage of the Internet?

OBJECTIVE: To analyze specialist doctors' opinions, attitudes and habits with respect to e-health, and the repercussions of these factors on doctor/patient relations. METHODOLOGY: Use of a survey to analyse attitudes, Internet use, habits and opinions about the advantages and disadvantages of the Internet among 302 doctors in eight Spanish hospitals. RESULTS: Of the doctors surveyed, 80% have access to and use the Internet. Almost 40% use the Internet for less than one hour a day; doctors in smaller hospitals spend more time on the Internet and men spend more time than women. The most frequently visited websites are PubMed (11%) and Google (22%); when choosing a website, periodical updating and prestige are important to 78% and 69%, respectively; 37% have taken a course through the Internet; 35% consult electronic journals systematically; 16% regularly collaborate with, or write materials for healthcare websites; 12% receive electronic mail from their patients. Three clusters of information were generated in this study to classify the participating hospital doctors: the different types of information the doctors consulted, the way the Internet enhances doctor/patient relations and the aspects that the doctors consider relevant when connecting to the Internet. CONCLUSIONS: Spanish doctors consider the Internet to be a tool that enhances doctor/patient relations. New technologies are accelerating the substitution of a paternalistic model by ones where the patient has access to more information and resources. There appears to be a favourable attitude towards seeking a second opinion through the Internet, although not towards patients' 'chats'.

Attitude of Health Personnel↗

PubMed2005

Few rural general practitioners use the Internet frequently in regard to patient care.

AIMS: To benchmark North Island rural general practitioner (GP) access to computers and the Internet, both at work and home, and assess whether rural GPs are using the Internet in regard to patient care. METHODS: Cross-sectional postal survey of all North Island rural GPs in mid-2003. RESULTS: 175 of 289 GPs (60.6%) returned useable questionnaires. Most (89.0%) reported computer availability at work when consulting, but even more had access to a computer at home (97.1%, p<0.01). Access to the Internet was also lower at work (68.6%) than at home (98.8%, p<0.01). Fewer GPs (p<0.05) reported ever using the Internet at work in regard to patients (56.5%) than at home (71.9%). Less than 10% of all GPs used the Internet three or more times a week at work (6.9%) or home (8.6%) in regard to patients. Of those with Internet access at work, 27.0% had broadband (fast Internet) access. Predictors of having (versus not having) work Internet access were computer availability in consultations (p=0.04). CONCLUSIONS: Few North Island rural GPs use the Internet frequently in regard to patient care, despite increasing access to computers and the Internet, both at work and home.

Computer Literacy↗

PubMed2005

Rural New Zealand health professionals' perceived barriers to greater use of the internet for learning.

INTRODUCTION: The purpose of this research was to investigate rural North Island (New Zealand) health professionals' attitudes and perceived barriers to using the internet for ongoing professional learning. METHODS: A cross-sectional postal survey of all rural North Island GPs, practice nurses and pharmacists was conducted in mid-2003. The questionnaire contained both quantitative and qualitative questions. The transcripts from two open questions requiring written answers were analysed for emergent themes, which are reported here. The first open question asked: 'Do you have any comments on the questionnaire, learning, computers or the Internet?' The second open question asked those who had taken a distance-learning course using the internet to list positive and negative aspects of their course, and suggest improvements. RESULTS: Out of 735 rural North Island health professionals surveyed, 430 returned useable questionnaires (a response rate of 59%). Of these, 137 answered the question asking for comments on learning, computers and the internet. Twenty-eight individuals who had completed a distance-learning course using the internet, provided written responses to the second question. Multiple barriers to greater use of the internet were identified. They included lack of access to computers, poor availability of broadband (fast) internet access, lack of IT skills/knowledge, lack of time, concerns about IT costs and database security, difficulty finding quality information, lack of time, energy or motivation to learn new skills, competing priorities (eg family), and a preference for learning modalities which include more social interaction. Individuals also stated that rural health professionals needed to engage the technology, because it provided rapid, flexible access from home or work to a significant health information resource, and would save money and travelling time to urban-based education. CONCLUSIONS: In mid-2003, there were multiple barriers to rural North Island health professionals making greater use of the internet for learning. Now that access to broadband internet is available in all rural towns in New Zealand, there is a clear need to address the other identified barriers, especially the self-reported lack of IT skills, which are preventing many in the rural health workforce from gaining maximum advantage from both computers and the internet.

Attitude of Health Personnel↗

PubMed1998

History, structure, and function of the Internet.

The Internet stands at the forefront of telecommunications in medicine. This worldwide system of computers had its beginnings in networking projects in the United States and western Europe in the 1960s and 1970s. The precursor of the Internet was ARPANET, a long-distance telecommunication network funded by the Department of Defense that linked together computers throughout the United States. In the 1980s, ARPANET was superseded by NSFNET, a series of networks created by the National Science Foundation, which established the present-day structure of the Internet. The physical structure of the Internet resembles and is integrated with the telephone system. Long-distance data transport services are provided by large telecommunication companies, called network service providers (NSPs), through high-capacity, high-speed national and international fiber optic cables. These transport services are accessed through Internet service providers, ISPs. ISPs, the equivalent of regional Bell operating companies, provide the physical link to the NSPs for individuals and organizations. Telecommunications on the Internet are standardized by a set of communications protocols, the TCP/IP protocol suite, that describe routing of messages over the Internet, computer naming conventions, and commonly used Internet services such as e-mail. At present, the Internet consists of over 20 million computer worldwide and is continuing to grow at a rapid rate. Along with the growth of the Internet, higher speed access methods are offering a range of new services such as real-time video and voice communications. Medical education, teaching, and research, as well as clinical practice, will be affected in numerous different ways by these advances.

Computer Communication Networks↗

PubMed2002

Internet hand x-rays: A comparison of joint space narrowing and erosion scores (Sharp/Genant) of plain versus digitized x-rays in rheumatoid arthritis patients.

BACKGROUND: The objective of the study is to examine the reliability of erosion and joint space narrowing scores derived from hand x-rays posted on the Internet compared to scores derived from original plain x-rays. METHODS: Left and right x-rays of the hands of 36 patients were first digitized and then posted in standard fashion to a secure Internet website. Both the plain and Internet x-rays were scored for erosions and joint space narrowing using the Sharp/Genant method. All scoring was completed in a blind and randomized manner. Agreement between plain and Internet x-ray scores was calculated using Lin's concordance correlations and Bland-Altman graphical representation. RESULTS: Erosion scores for plain x-rays showed almost perfect concordance with x-rays read on the Internet (concordance 0.887). However, joint space narrowing scores were only "fair" (concordance 0.365). Global scores demonstrated substantial concordance between plain and Internet readings (concordance 0.769). Hand x-rays with less disease involvement showed a tendency to be scored higher on the Internet versions than those with greater disease involvement. This was primarily evident in the joint space narrowing scores. CONCLUSIONS: The Internet represents a valid medium for displaying and scoring hand x-rays of patients with RA. Higher scores from the Internet version may be related to better viewing conditions on the computer screen relative to the plain x-ray viewing, which did not include magnifying lens or bright light. The capability to view high quality x-rays on the Internet has the potential to facilitate information sharing, education, and encourage collaborative studies.

Journal Article↗

PubMed2006

Use of the Internet for health information by physicians for patient care in a teaching hospital in Ibadan, Nigeria.

BACKGROUND: The Internet is the world's largest network of information, communication and services. Although the Internet is widely used in medicine and has made significant impact in research, training and patient care, few studies had explored the extent to which Nigerian physicians use Internet resources for patient care. The objective of this study was to assess physicians' use of the Internet for health information for patient care. METHOD: 172 physicians at the University College hospital (UCH) Ibadan, Nigeria; completed a 31-item, anonymous, standardized questionnaire. The Epi-Info software was used for data analysis. RESULTS: The mean age of the respondents was 31.95 years (SD 4.94). Virtually all (98%) the respondents had used the Internet; 76% accessed it from cyber cafes. E-mail was the most commonly used Internet service (64%). Ninety percent of the respondents reported they had obtained information from the Internet for patient care; of this number, 76.2% had searched a database. The database most recently searched was MEDLINE/PubMed in 99% of cases. Only 7% of the respondents had ever searched the Cochrane Library. More than half (58.1%) perceived they had no confidence to download full-text articles from online sources such as the Health Internetwork Access to Research Initiative (HINARI). Multiple barriers to increased use of the Internet were identified including poor availability of broadband (fast connection speed) Internet access, lack of information searching skills, cost of access and information overload. CONCLUSION: Physicians' use of the Internet for health information for patient care was widespread but use of evidenced-based medicine resources such as Cochrane Library, Up-to-date and Clinical Evidence was minimal. Awareness and training in the use of EBM resources for patient care is needed. Introduction of EBM in the teaching curriculum will enhance the use of EBM resources by physicians for patient care.

Journal Article↗

PubMed1994

Service providers and users discover the Internet.

Although the Internet has evolved over more than twenty years, resources useful to health information professionals have become available on the Internet only recently. A survey conducted by the Regional Medical Libraries of the National Network of Libraries of Medicine in the fall of 1993 indicates that libraries at academic institutions are much more likely to have access to the Internet (72%) than are libraries in hospital environments (24%). Health information professionals who take on the challenge and exploit the Internet's resources find rewards for themselves and their clients. The basic electronic mail capability of the Internet allows colleagues to collaborate, communicate, and participate in daily continuing education. Internet terminal and file-transfer capabilities provide improved access to traditional resources and first-time access to new electronic resources. Through the Internet, online catalogs are available worldwide, and document delivery is faster, cheaper, and more reliable than ever before. Institutions can make organizational, full-text, online, and publication information available through Internet tools such as direct file-transfer protocol (FTP), menu-based Gopher, and hypertext-based Mosaic. The National Library of Medicine (NLM) is among organizations finding new ways to provide service through the Internet. NLM now uses electronic mail to communicate with users, FTP service to distribute publications, and tools such as Gopher and Mosaic to distribute publications and graphics and connect users to online services. The Internet allows service providers and health sciences information professionals to work in a rich, new medium whose potential is just beginning to be explored. At the same time, its characteristics--including lack of formal organization, standards, quality control, and permanence--pose a challenge.

Computer Communication Networks↗

PubMed2000

The Internet as a source of medical information. Investigation in a mixed cohort of radiotherapy patients.

BACKGROUND: The widespread use of the internet has influenced patterns of medical information for tumor patients. The present study examines the use of various media and, in particular, the application of the internet, in a mixed cohort of radiotherapy patients. PATIENTS AND METHODS: All patients undergoing radiotherapy at the University of Würzburg were analyzed simultaneously in May of 2000 using a newly developed 9-item questionnaire. Questions related to the importance of various media for medical information (grading from 0 = unimportant to 2 = very important) and previous internet use. The data was correlated with clinical information from the patients' charts. RESULTS: In 95% of patients (n = 139) questionnaires were evaluable. Of 8 media, television (mean score 0.94), patient brochure (0.83) and newspaper (0.76) were considered most important for medical information while the internet ranged last (0.24). Whereas 61.2% knew the internet as a source of medical information, only 11.5% had searched the internet themselves and 15.1% had received internet information from family or friends. Only 24.1% from these 2 groups had discussed the information with their physician. The rates of internet use were substantially higher in subgroups with younger age, higher education and palliative treatment. CONCLUSION: The importance of the medium internet for the information of tumor patients is currently still low but likely to increase based on demographic factors.

Adult↗

PubMed2004

Patterns of Internet use by persons with spinal cord injuries and relationship to health-related quality of life.

OBJECTIVES: To examine patterns of computer and Internet use among persons with spinal cord injuries (SCI) and to assess the relationship between Internet use and health-related quality of life (HRQOL). DESIGN: Cross-sectional survey design. SETTING: National Model Spinal Cord Injury Systems. PARTICIPANTS: People with SCI enrolled in a national database. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patterns of Internet use and relationship to HRQOL indicators: self-perceived health status, health status compared with 1 year ago, severity of depression, social integration score, occupation score, contacts with friends, business contacts, and satisfaction with life. RESULTS: Most subjects owned computers, had Internet access, and used the Internet regularly-primarily for email, disability and health information, and shopping. Bivariate analysis revealed significant differences in Internet access based on sociodemographics, particularly among subjects with less education and among African Americans and Hispanics. In initial univariate analysis, most HRQOL indicators were significantly better for Internet users; once sociodemographic factors were included, 4 indicators remained significant. CONCLUSIONS: Complex factors contribute to Internet access among people with SCI, with more barriers among specific subgroups. A significant HRQOL benefit from Internet use is suggested. Targeted interventions and studies of usage patterns are recommended.

Adult↗

PubMed2004

Patterns of Internet use: bariatric versus colorectal patients in a private institution.

BACKGROUND: The frequency of Internet use for self-directed medical care in different patient populations is increasing. We evaluated Internet use by patients presenting for bariatric surgery. STUDY DESIGN: Surveys were completed by 136 patients (109 women, 22 men) presenting to a private academic clinic for bariatric surgery. Data collected included age, gender, education level, household income, and pattern of Internet use. Comparisons were made with a group of 135 patients who visited a colorectal surgery clinic in the same institution. RESULTS: Bariatric patients who used the Internet were more likely than colorectal patients to inform themselves about their medical problem (76% versus 49%, p < 0.001) and tended to use the Internet more overall (85% versus 78%, p = ns). Use of the Internet to research bariatric surgery was associated with education level (p = 0.002) and household income (p = 0.01), but not with age or gender. Bariatric patients were more likely than colorectal patients to search our institution's Web site (40% versus 17%, p < 0.001) and to use the Internet to find out about their surgeon (47% versus 31%, p = 0.01). Only 9% of bariatric patients used a chat room. Ninety-six percent of bariatric patients found the information on the Internet easy to understand and 58% described it as very helpful. CONCLUSIONS: Bariatric patients are especially likely to use the Internet to gain information about their medical condition, possibly reflecting their limited mobility. This represents an educational opportunity for the surgical community.

Adult↗

PubMed2005

Health information-seeking behaviour in adolescence: the place of the internet.

The internet is one of a range of health information sources available to adolescents. It is recognised that young people have difficulties accessing traditional health services; in theory, the internet offers them confidential and convenient access to an unprecedented level of information about a diverse range of subjects. This could redress adolescents' state of relative health 'information poverty', compared to adults. This paper seeks to explore United Kingdom (UK) and United States (US) adolescents' perceptions and experiences of using the internet to find information about health and medicines, in the context of the other health information sources that are available to them. The study involved a series of 26 single-gender focus groups with 157 English-speaking students aged 11-19 years from the UK and the US. Many students reported that the internet was their primary general information source. Information sources were defined during analysis in terms of previous experience of the source, saliency of the available information, and credibility of the source (defined in terms of expertise, trustworthiness and empathy). Most focus group participants had extensive personal experience with the internet and some information providers therein (notably search engines). Internet health information was regarded generally as salient. Its saliency was increased through active searching and personalisation. Perceived credibility of the internet varied because expertise and trustworthiness were sometimes difficult to determine, and empathy could be facilitated through online communities but the individual could control disclosure. The internet combines positive features of traditional lay and professional, personal and impersonal sources. Although it is unlikely to supplant the role of trusted peers and adults, the internet has found an important place among adolescents' repertory of health information sources.

Adolescent↗

PubMed2003

Women's health and the internet: understanding emerging trends and implications.

Internet has become a major information source, yet little is known about why women use the internet for obtaining health information. In this paper, we propose and test three exploratory models to explain internet use for obtaining health information: health and wellness model, health needs model, and search costs model. The health and wellness model is based on the notion that internet has become such an integral part of daily life that health-conscious women use the internet in a pro-active manner for health promotion. The health needs model posits that women with greater health needs or concerns are more likely to use the internet. Finally, the search costs model explores the idea that women may view the internet as a resource for reducing high information search costs. These models were tested using data collected through telephone surveys of women in three southern New Jersey counties in the USA. Consistent with expectations, our findings show that internet use to search for health information is greater among women with higher levels of income and education. There is support for all three models, with surprisingly strong support for the health and wellness model. We conclude that women increasingly rely on the internet to supplement health information received from traditional sources and discuss the implications of our findings for policymakers and health professions.

Adolescent↗

PubMed2006

Potential markers for problematic internet use: a telephone survey of 2,513 adults.

OBJECTIVE: The Internet has positively altered many aspects of life. However, for a subset of users, the medium may have become a consuming problem that exhibits features of impulse control disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. METHOD: This is the first large-scale epidemiological study of problematic Internet use through a random-digit-dial telephone survey of 2,513 adults in the United States. Given the lack of validated criteria, survey questions were extrapolated from established diagnostic criteria for impulse control disorders, obsessive-compulsive disorder, and substance abuse. Four possible diagnostic criteria sets were generated. The least restrictive set required the respondent to report an unsuccessful effort to reduce Internet use or a history of remaining online longer than intended, Internet use interfering with relationships, and a preoccupation with Internet use when offline. RESULTS: The response rate was 56.3%. Interviews averaged 11.3 minutes in duration. From 3.7% to 13% of respondents endorsed > or =1 markers consistent with problematic Internet use. The least restrictive proposed diagnostic criteria set yielded a prevalence of problematic Internet use of 0.7%. CONCLUSION: Potential markers of problematic Internet use seem present in a sizeable proportion of adults. Future studies should delineate whether problematic Internet use constitutes a pathological behavior that meets criteria for an independent disorder, or represents a symptom of other psychopathologies.

Adult↗

PubMedDate not supplied

Patient and caregiver interest in internet-based cancer services.

PURPOSE: The primary goal of this study was to identify the needs for, the interest in, and the feasibility of the implementation of an Internet-based cancer services web site. Additionally, group differences (racial, patient vs caregiver, or rural vs urban) were identified that might influence the implementation of such a project. DESCRIPTION OF STUDY: Patients with cancer and caregivers (N = 319) in the waiting rooms of a cancer center located within a southeastern medical university completed questionnaires regarding their interest in Internet-based services. Topics included the likelihood of using Internet-based services, interest in home healthcare services delivered via a personal computer, and knowledge about and use of the Internet. RESULTS: Results indicated that most patient and caregiver respondents were interested in Internet-based cancer-related services such as information related to treatment (80%), conversations with physicians via the Internet (70%), and online support groups (65%). In addition, respondents reported that they would be likely to use such services (70%) and were interested in home healthcare services delivered via personal computers (60%). No group differences were found across ethnic groups, geographic settings, and patient status (patient vs caregivers) on these variables. Minorities, older individuals, and less educated individuals were less likely to have knowledge of and to have used the Internet. CLINICAL IMPLICATIONS: Patients with cancer and their caregivers are interested in supplementing in-person services with Internet-based services relating to their cancer treatment. Special efforts need to be made to reach ethnic minorities, the elderly, and those with less education with Internet-based programs.

Adolescent↗