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PubMed2006

Changing availability and cost of Internet physician consultations and prescription medications.

INTRODUCTION: Internet use by the public to obtain medical information and services continues to grow. In 1999, we found cost of general physician visits was 15% higher, and cost of medications was 10% greater via the Internet than from community providers. The goal of this study was to re-examine changes in product availability and costs to consumers four years later. DESIGN: We searched multiple websites 1 June 2003 - 31 August 2004, offering physician consultations and prescription medications. We compared mean cost of Internet physician visits and price per pill to costs of community-based general physicians and pharmacies in the Philadelphia region. RESULTS: We found 144 sites worldwide providing physician services and prescription medications. Mean charge for an Internet physician consultation was 55 dollars, 8.3% lower than for a comparable visit to a community practitioner. Mean cost per pill across 204 available medications was 36.7% higher at Internet sites than at local pharmacies. Shipping and handling (S&H) added a mean of 15.40 dollars. Total cost to Internet consumers was similar whether or not Internet sites charged for a physician consultation and/or S&H. Obtaining physician visits and medications over the Internet was about 40% more costly than in the local community. CONCLUSION: The Internet continues to hold great promise for provision of health and medical care services by expanding access. However, increased access to physician care and medications entails higher cost, and quality of physician services and pharmaceuticals provided remain controversial.

Health Expenditures↗

PubMed2005

Acculturative stress and use of the Internet among East Asian international students in the United States.

This study investigated the relationships between acculturative stress of East Asian international students and their use of the Internet, taking into account Internet types (English-language Internet and native-language Internet) and Internet motives. A survey was conducted among 115 East Asian international students who attended a large urban university in the southeastern United States. On average, students used English-language Internet more than native-language Internet. A positive correlation was found between using English-language Internet and English proficiency. The analysis identified three Internet motives: information seeking, relaxation/entertainment, and social utility. Perceived discrimination was a positive predictor of the motives of social utility and relax/entertainment. Fear was a positive predictor of the motive of social utility.

Acculturation↗

PubMed2001

Physicians and the Internet: understanding where we are and where we are going.

The growth of the Internet for both commercial and personal use is the target of much analysis. Within the health care industry, physician use of the Internet has become the wobbly cornerstone upon which many Internet-based health care companies have built their business plans. This article presents the argument that significant physician use of the Internet is dependent on many factors that are not related to the Internet per se but rather to the use of technology in general. Using industry standard nomenclature, the authors have developed a simple taxonomy that categorizes Internet applications relevant to physicians. We review the growth of electronic prescribing and electronic medical records relative to the Internet and the impact of new data entry and retrieval technologies. We discuss the effects of the Internet on workflow and quality of care. Finally, we cast our gaze forward to 2005 and discuss how adoption of the Internet and new technologies may impact physicians and patients in the future.

Ambulatory Care Information Systems↗

PubMed2001

Medical group adoption of Internet services.

Physician leaders and office-based practicing physicians in medium and large practice organizations were surveyed regarding their use of administrative and clinical systems enabled by the Internet. More than 85% of medical groups reported using one or more Internet-enabled services and 35 reported use of more than five Internet-enabled services, including both business and clinical applications. Physician leaders and practicing physicians identified six Internet-enabled services as "essential" for the future success of their practice and indicated that reduced administrative costs, faster payments, and improved quality of care are the most important benefits derived from Internet-enabled applications. Ninety-six percent of survey respondents estimated that Internet-enabled technologies will have a significant, positive impact on the practice of medicine in general and will improve the quality of care before 2003. The lack of industrywide standards for health information and the inability of current computer systems to exchange information across health care delivery networks were cited as the most important barriers to the adoption of Internet-enabled applications by physicians. Respondents believed that action by the Health Care Financing Administration (HCFA) or major health plans to require participating physicians to use the Internet for administrative services will be needed to bring about rapid migration to Internet-enabled services.

Ambulatory Care Information Systems↗

PubMedDate not supplied

Internet users becoming immersed in the virtual world. Implications for nurses.

Worldwide, people are using the Internet for computer-mediated communication (CMC) in increasing numbers. Nurse researchers have begun to examine the use of this medium for communication, education, and support of their clients. Therefore, it is important to know the experiences and meanings of CMC if the Internet is to be used for nursing interventions. The purpose of this study was to examine the experiences and meaning of online communications for frequent Internet users and discuss implications for nursing practice. Four virtual focus groups consisting of a total of 32 individuals were included in this study. Their stories of everyday Internet use were analyzed by hermeneutic interpretation. Six related themes and 1 constitutive pattern emerged from the data: (1) Internet as a resource for communication, information, and entertainment; (2) Internet as appealing, drawing one into frequent use; (3) developing dependencies; (4) Internet as frustrating; (5) learning the rules; and (6) developing physical and psychosocial effects. The constitutive pattern is immersion into the virtual world. This knowledge can be used to identify the potential effects of integrating the Internet into nursing interventions. Nurses who plan Internet-based interventions need to understand the appeal of this medium as well as the limitations and barriers to use.

Adult↗

PubMed2005

Gay men who look for sex on the Internet: is there more HIV/STI risk with online partners?

OBJECTIVE: To examine whether the excess risk for HIV and sexually transmitted infection (STI) seen among gay men who look for sex through the Internet occurs with men they meet online (through the Internet) rather than offline (in bars, clubs, etc). METHODS: In 2002-2003, 4225 London gay men were surveyed in an HIV treatment clinic, HIV testing clinic, gyms and on UK Internet sites (gaydar and gay.com). All men completed a self-administered questionnaire concerning Internet use and sexual risk behaviour. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status was classified as non-concordant. RESULTS: Between 40 and 50% of men surveyed in the clinics and gyms used the Internet to look for sex. HIV-positive men who looked for sex through the Internet were more likely to report UAI with HIV-positive casual partners they met online rather than offline (clinic sample: met online only 9.9%, met offline only 3.8%, McNemar P < 0.05). Regardless of HIV status, however, men who looked for sex through the Internet were no more likely to report UAI with non-concordant casual partners they met online than offline (eg, HIV-negative men, Internet sample: met online only 9.7%, offline only 11.1%, McNemar P = 0.6). CONCLUSIONS: In London, HIV-positive gay men appear to meet casual UAI partners of the same status through the Internet. This presents a risk for STI transmission. However, gay men were no more likely to meet casual UAI partners of unknown or discordant HIV status--which presents a risk for HIV transmission--online rather than offline.

Adolescent↗

PubMed2005

Surfing for scoliosis: the quality of information available on the Internet.

STUDY DESIGN: A cross section of Web sites accessible to the general public was surveyed. OBJECTIVE: To evaluate the quality and accuracy of information on scoliosis that a patient might access on the Internet. SUMMARY OF BACKGROUND DATA: The Internet is a rapidly expanding communications network with an estimated 765 million users worldwide by the year 2005. Medical information is one of the most common sources of inquires on the Web. More than 100 million Americans accessed the Internet for medical information in the year 2000. Undoubtedly, the use of the Internet for patient information needs will continue to expand as Internet access becomes more readily available. This expansion combined with the Internet's poorly regulated format can lead to problems in the quality of information available. Since the Internet operates on a global scale, implementing and enforcing standards have been difficult. The largely uncontrolled information can potentially negatively influence consumer health outcomes. METHODS: To identify potential sites, five search engines were selected and the word "scoliosis" was entered into each search engine. A total of 50 Web sites were chosen for review. Each Web site was evaluated according to the type of Web site, quality content, and informational accuracy by three board-certified academic orthopedic surgeons, fellowship trained in spinal surgery, who each has been in practice for a minimum of 8 years. Each Web site was categorized as academic, commercial, physician, nonphysician health professional, and unidentified. In addition, each Web site was evaluated according to scoliosis-specific content using a point value system of 32 disease-specific key words pertinent to the care of scoliosis on an ordinal scale. A list of these words is given. Point values were given for the use of key words related to disease summary, classifications, treatment options, and complications. The accuracy of the individual Web site was evaluated by each spine surgeon using a scale of 1 to 4. A score of 1 represents that the examiner agreed with less than 25% of the information while a score of 4 represents greater than 75% agreement. RESULTS: Of the total 50 Web sites evaluated, 44% were academic, 18% were physician based, 16% were commercial, 12% were unidentified, and 10% were nonphysician health professionals. The quality content score (maximum, 32 points) for academic sites was 12.6 +/- 3.8, physician sites 11.3 +/- 4.0, commercial sites 11 +/- 4.2, unidentified 7.6 +/- 3.9, and nonphysician health professional site 7.0 +/- 1.8. The accuracy score (maximum, 12 points) was 6.6 +/- 2.4 for academic sites, 6.3 +/- 3.0 for physician-professional sites, 6.0 +/- 2.7 for unidentified sites, 5.5 +/- 3.8 for nonphysician professional sites, and 5.0 +/- 1.5 for commercial Web sites. The academic Web sites had the highest mean scores in both quality and accuracy content scores. CONCLUSION: The information about scoliosis on the Internet is of limited quality and poor information value. Although the majority of the Web sites were academic, the content quality and accuracy scores were still poor. The lowest scoring Web sites were the nonphysician professionals and the unidentified sites, which were often message boards. Overall, the highest scoring Web site related to both quality and accuracy of information was www.srs.org. This Web site was designed by the Scoliosis Research Society. The public and the medical communities need to be aware of these existing limitations of the Internet. Based on our review, the physician must assume primary responsibility of educating and counseling their patients.

Cross-Sectional Studies↗

PubMed2004

Nurses' use of the Internet in clinical ward settings.

BACKGROUND: The potential of the Internet as a fast and efficient way of accessing evidence to support nursing practice has been well recognized. In addition, nurses have highlighted the need for training in the use of information technology, information retrieval and critical appraisal as essential to their professional development. AIM: The aim of this paper is to present selected results of a longitudinal project that evaluated the impact of networked computers, with open access to the Internet, on four acute wards in a large UK teaching hospital. METHOD: Evaluation methods in the project included monitoring data from an Internet surveillance software package, a questionnaire survey with the nurses (n = 97) and in-depth interviews with a sample of nurses (n = 12). FINDINGS: A complex picture was revealed of the nature of Internet use and the factors that nurses perceived as influencing this. The majority used the networked computers and some frequent users emerged. Nurses were able to use the technology during quiet periods throughout the day and night. Patterns of use were mixed, with nurses accessing the Internet for a combination of work and non-work-related activities. They integrated use of Internet technology into their working days in ways that appropriately fitted patterns of clinical activity. Factors relating to the organization, workplace culture and training were identified influencing Internet use. CONCLUSIONS: Open access to the Internet in the workplace emerged as a useful but unrefined tool for encouraging the retrieval of information for practice. Future development of this technology in the workplace must include support and training for professional staff in order to enhance the skills required. Recommendations are made about what and how training may be useful in promoting nurses' use of Internet technology in clinical settings.

Access to Information↗

PubMed2004

Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years).

The use of the Internet has increased considerably during the last few years, and there are also some clinical observations that some people 'get hooked', and develop an Internet addiction. An epidemiological study was performed in a representative sample of the Norwegian youth population (N= 3,237; response rate 45.2%). The proportion not using Internet was only 4.9%, while 35.8% were non-frequent users, and 49.6% (1,591) were frequent (weekly) users. They used the Internet on the mean 4.3 hours a week. A mean of 1.98% (boys 2.42%, girls 1.51%) could be described as having an 'Internet addiction' according to the criteria in the Diagnostic Questionnaire of Young (1998), and an additional 8.68% (in sum 10.66) were considered to have an at-risk Internet use (boys 9.21%, girls 8.13%). If these proportions were calculated on individuals who used the Internet frequently, 4.02% fulfilled 5 criteria, and an additional 17.66% 3-4 criteria, giving quite high figures of problematic Internet use (in sum 21.68). The different diagnostic criteria gave a broad range of affirmative answers (from 0.4% to 27.9%). The results have important implications for further studies of prevalence, implementation of preventive measures, and the development of treatment approaches for Internet addiction.

Adolescent↗

PubMed2006

Assessment of internet use and effects among healthcare professionals: a cross sectional survey.

PURPOSE: Several studies have explored the scientific platforms on patient use of the internet for health information. In contrast physicians' perspective on evolving internet environment is lacking. The purpose of this study is to assess and correlate the extent of internet use among healthcare professionals and examine its effects on clinical practice. METHODS: Cross sectional survey conducted in the USA using questionnaires distributed randomly to healthcare professionals attending distinct continuing medical education programmes between 2003 and 2004. Multiple choice and yes/no questions related to the trends of internet use and its effects on clinical practice were extracted and responses analysed. The main outcome measures are self reported rates of internet use, perceived effects, and the role of medical web sites in clinical practice. RESULTS: The overall response rate was 60%. A total of 277 survey respondents (97%) had internet access. Some 7% in private practice and 1% of group practice physicians did not have internet access. Most (71%) used the internet regularly for medical or professional updating and 62% (n = 178) felt the need for sharing web sites designed for healthcare professionals with patients. Some 27% of the physicians currently own established personal practice web sites. Sixty three per cent have recommended a web site to a patient for more information, matching the positive trust (>70%) on the general quality of selected medical web sites. CONCLUSION: This cross sectional survey shows that internet use and web based medical information is widely popular among physicians and patients. About 23%-31% of the healthcare professionals report >80% interaction with web informed patients in their daily practice.

Adult↗

PubMedDate not supplied

Smokers' beliefs and attitudes about purchasing cigarettes on the Internet.

OBJECTIVES: Our objectives were to explore qualitatively how smokers find out about Internet cigarette sales and what factors motivate them to purchase cigarettes on-line, and to quantitatively describe the Internet cigarette purchasing behaviors and attitudes of Internet cigarette buyers. METHODS: Qualitative in-depth telephone interviews were conducted with 21 adult smokers who had purchased or contemplated purchasing cigarettes online. Findings from the qualitative study were used to develop a survey module on Internet cigarette purchasing behavior that was administered to 187 New Jersey adult smokers. RESULTS: Smokers who purchased cigarettes on-line were primarily motivated by lower prices, which occur because Internet vendors generally sell cigarettes without paying excise taxes for the destination state. Most Internet cigarette buyers first learned about on-line cigarette sales from interpersonal sources who had purchased on-line. New Jersey adult smokers who purchased cheaper cigarettes from the Internet and other lower-taxed sources significantly increased their consumption over time, compared to smokers who reported paying full-price at traditional bricks-and-mortar retail stores. CONCLUSIONS: Policies that have the effect of equalizing Internet cigarette prices with those at retail stores will likely deter smokers from purchasing cigarettes on-line. Internet cigarette vendors should be required to comply with the same provisions that apply to bricks-and-mortar retail vendors and charge appropriate state and local cigarette excise taxes. In the absence of such policies, the sales of cheaper, tax-free cigarettes on-line will undermine the public health benefit of raising cigarette prices.

Attitude↗

PubMed2007

The prevalence and inaccessibility of Internet references in the biomedical literature at the time of publication.

OBJECTIVES: To determine the prevalence and inaccessibility of Internet references in the bibliography of biomedical publications when first released in PubMed. METHODS: During a one-month observational study period (Feb 21 to Mar 21, 2006) the Internet citations from a 20% random sample of all forthcoming publications released in PubMed during the previous day were identified. Attempts to access the referenced Internet citations were completed within one day and inaccessible Internet citations were recorded. RESULTS: The study included 4,699 publications from 844 different journals. Among the 141,845 references there were 840 (0.6%) Internet citations. One or more Internet references were cited in 403 (8.6%) articles. From the 840 Internet references, 11.9% were already inaccessible within two days after an article's release to the public. CONCLUSION: The prevalence of Internet citations in journals included in PubMed is small (<1%); however, the inaccessibility rate at the time of publication is considered substantial. Authors, editors, and publishers need to take responsibility for providing accurate and accessible Internet references.

Access to Information↗

PubMed2004

Recruitment of patients into an internet-based clinical trials database: the experience of OncoLink and the National Colorectal Cancer Research Alliance.

PURPOSE: In March 2001, the National Colorectal Cancer Research Alliance (NCCRA) and OncoLink (http://www.oncolink.org) established a database to facilitate patient enrollment onto clinical trials. This study describes the population registering with the database and identifies discrepancies between individuals registering through the Internet and those registering through a telephone call center. METHODS: Participants registered with the NCCRA/OncoLink database through the Internet or a telephone call center. All participants entering the database completed a questionnaire regarding basic demographics, colon cancer risk factors, and indicated how they became aware of the database. Comparisons were made between individuals registering through the Internet and those registering through the telephone call center. RESULTS: A total of 2,162 participants registered during the first 16 months of the database. Most patients registered through the Internet rather than the telephone call center (88% v 12%; P < .001). More females than males registered (73% v 27%; P < .001). The majority (89%) were white. Participants registering through the Internet were younger than those registering through the call center (mean, 48.8 v 55.0 years; P < .001). There was no difference between the two groups with regard to sex or ethnicity. CONCLUSION: The Internet has the potential to increase the likelihood that interested individuals find appropriate clinical trials. Some of the discrepancies that are known to exist for access to the Internet were also seen for those registering with the database through the Internet. Despite these differences, the potential to increase clinical trial enrollment with this type of Internet-based database is high.

Adolescent↗

PubMed2005

The influence of the Internet on decision making in acoustic neuroma.

OBJECTIVE: To determine the access to and the use of the Internet by acoustic neuroma patients as a medical information source, and the influence of the Internet on decision-making, as well as the patients' views on the quality of particular sites. MATERIALS AND METHODS: A retrospective 27-item questionnaire was sent to 138 consecutive acoustic neuroma patients diagnosed between 1997 and 2002. The study included patients treated by conservative, radiotherapeutic and surgical modalities. MAIN OUTCOME MEASURES: Patient demographics, the extent of Internet use as well as quality and quantity of available information. RESULTS: There were 86.95 per cent questionnaires available for analysis. Twenty-four per cent accessed the Internet to obtain information about acoustic neuromas. Ninety-seven per cent of patients said that the information provided in the clinic matched with the information obtained from the websites, 49 per cent said that the information obtained from the Internet did not influence decision making regarding acceptance of treatment of their tumour. Some patients said the Internet information was depressing, devastating, and they would never look up the Internet again for medical information. CONCLUSION: A significant proportion of our patients accessed the Internet for information. Caution should be exercised when advising patients regarding websites as the information on the Internet is often not controlled or checked for accuracy. Acoustic neuroma specialists and ENT surgeons in general should familiarize themselves with related websites so that patients can then be directed to high-quality sites.

Attitude to Health↗

PubMed2003

Hospital marketing and the Internet: the adoption of an innovation.

Given the manner in which the Internet permeates today's society, it is easy to forget that the Internet as we know it is only about a decade old. Due to its newness, the Internet has provided an opportunity to view the manner in which marketers move to adopt such an innovation. To that end, since 1995 a series of studies has tracked the adoption and use of the Internet by hospital marketers. In addition to simply investigating the number of hospitals that utilize the Internet in their marketing efforts, the studies have addressed such questions as: How are hospitals using the Internet to market themselves?, What roadblocks have held hospitals back from adopting the Internet as a marketing tool?, and How happy are hospitals with their Internet investment? This manuscript details the most recent in this series of research studies. In addition, the authors compare the results of this study, conducted in the fall of 2002, with the results from the previous studies. As a result, this study provides a unique opportunity to observe the actual adoption of an innovation, the Internet, by hospital marketing professionals.

Costs and Cost Analysis↗

PubMedDate not supplied

Perceptions about computers and the internet in a pediatric clinic population.

BACKGROUND: A digital divide with respect to computer and Internet access has been noted in numerous studies and reports. Equally important to ownership is comfort with computers and Internet technology, and concerns about privacy of personal data. OBJECTIVE: To measure how households in a pediatric clinic vary in their attitudes toward computers, concerns about Internet confidentiality, and comfort using the Internet and whether these views are associated with household income or education. DESIGN/METHODS: A phone survey was administered to a population-based sample of parents with children aged 0 to 11 years. All children received medical care from a community-based clinic network serving patients in King County, Wash. RESULTS: Eighty-eight percent of respondents used a computer once a week or more, and 83% of respondents reported favorable feelings toward computers. Although 97% of respondents were willing to share personal information over the Internet, many respondents considered data security important. While household income and parental education were associated with comfort and familiarity with computers, the effect is small. Respondents who already owned a computer and had Internet access did not differ in their perceptions according to socioeconomic or educational attainment. CONCLUSIONS: Most families like using computers and feel comfortable using the Internet regardless of socioeconomic status. Fears about the digital divide's impact on the attitudes of parents toward computers or their comfort using the Internet should not be seen as a barrier to developing Internet-based health interventions for a pediatric clinic population.

Adult↗

PubMed2005

Internet use in the bariatric surgery patient population.

BACKGROUND: Many patients rely on the Internet for gathering medical information. Bariatric patients appear to explore the Internet for information regarding weight loss surgery. This investigation studied the hypothesis that Internet use is common among the bariatric population. METHODS: From Oct 1 to Dec 31, 2003, every patient who visited our bariatric clinic was asked to fill out a questionnaire. This survey contained questions concerning use of the Internet and E-mail. RESULTS: Of the 127 respondents, 89% owned a computer, had Internet access, and had an E-mail address. 85% of the patients had searched the Internet for bariatric information, and 98% of these patients (91/93) found the information useful. Of the patients who had access to the Internet, 36% searched for information about the hospital, 40% about the clinic, and 54% about the surgeon. Most of the patients believed that all doctors and all clinics should be available via E-mail (88% and 92% respectively). CONCLUSIONS: Most patients who come to a bariatric clinic are Internet savvy. It is helpful for bariatric surgeons and clinics to post information about themselves on the Internet and to be available via E-mail.

Adolescent↗

PubMed2004

Internet versus mailed questionnaires: a randomized comparison (2).

BACKGROUND: Low response rates among surgeons can threaten the validity of surveys. Internet technologies may reduce the time, effort, and financial resources needed to conduct surveys. OBJECTIVE: We investigated whether using Web-based technology could increase the response rates to an international survey. METHODS: We solicited opinions from the 442 surgeon-members of the Orthopaedic Trauma Association regarding the treatment of femoral neck fractures. We developed a self-administered questionnaire after conducting a literature review, focus groups, and key informant interviews, for which we used sampling to redundancy techniques. We administered an Internet version of the questionnaire on a Web site, as well as a paper version, which looked similar to the Internet version and which had identical content. Only those in our sample could access the Web site. We alternately assigned the participants to receive the survey by mail (n=221) or an email invitation to participate on the Internet (n=221). Non-respondents in the mail arm received up to three additional copies of the survey, while non-respondents in the Internet arm received up to three additional requests, including a final mailed copy. All participants in the Internet arm had an opportunity to request an emailed Portable Document Format (PDF) version. RESULTS: The Internet arm demonstrated a lower response rate (99/221, 45%) than the mail questionnaire arm (129/221, 58%) (absolute difference 13%, 95% confidence interval 4%-22%, P<0.01). CONCLUSIONS: Our Internet-based survey to surgeons resulted in a significantly lower response rate than a traditional mailed survey. Researchers should not assume that the widespread availability and potential ease of Internet-based surveys will translate into higher response rates.

Adult↗