Filling the gaps in physician communication. The role of the Internet among primary care patients

The Roles of Education, Literacy, and Numeracy in Need for Health Information during the Second Half of Adulthood: A Moderated Mediation Analysis

We examine complex pathways that link health information seeking behavior with education and health literacy (decomposed into general literacy and numeracy), and how these pathways differ by perceived health status (need) among a nationally representative sample of Americans age 50 and older (n = 2,750). Data come from the Program for International Assessment of Adult Competencies (PIAAC). Multi-group structural equation models were used to examine the use of eight health information sources (newspapers, magazines, internet, radio, TV, books, friends/family, and health professionals). Findings partially support the long-standing notion that health seeking behaviors are directly linked to educational attainment, and provide some of the first nationally representative evidence for how education functions through distinct health literacy components to shape health information seeking behaviors by health status. Findings from this moderated mediation analysis point to the importance of examining, and addressing, health literacy disparities in access to and use of health information.

Online Health Searches and Their Perceived Effects on Patients and Patient-Clinician Relationships: ASystematic Review

Online health searches are common and may be impacting patients and their relationships with their clinicians in ways that are not fully understood. We searched PubMed, Embase, Cochrane Reviews, Cochrane Trials, Scopus, and CINAHL from January 1, 1990 to January 29, 2016 for studies in which patients searched online for any aspect of health care and then visited their clinician. We extracted data pertaining to either patients' or clinicians' perceptions of the effects of these online searches on patients and the patient-clinician relationship. Searches seemed to induce patient anxiety but more often led to patient reassurance, clinical understanding, and empowerment. Patients tended to perceive that online health searches had a positive effect on the patient-clinician relationship, although the nature of the effect could depend on the clinician's response to patient queries about the information. Clinicians generally perceived neutral effects on patients and the patient-clinician relationship and commonly raised concerns about the accuracy of online content. Significant methodologic heterogeneity prevented quantitative synthesis. Accuracy of online health search content was not assessed, and randomized controlled trials were notably lacking.

The Patient Experience: An Analysis of Orthopedic Surgeon Quality on Physician-Rating Sites

BACKGROUND

With the advent of the Consensus Core of Orthopedic Measures, arthroplasty surgeons are increasingly subjected to public performance reviews on physician-rating sites. Therefore, we evaluated (1) web site details of physician-rating sites, (2) differences between sites and the Consensus Core, (3) published patient experiences, (4) search rank among sites, and (5) differences between academic vs nonacademic and arthroplasty vs nonarthroplasty surgeons.

METHODS

The 5 busiest physician-rating sites were analyzed. To compare physician-rating sites to the Consensus Core, 3 reviewers analyzed the web site details. To evaluate patient ratings and reviews, orthopedists from the top 5 academic and nonacademic hospitals (2016 US News & World Report) were analyzed. Institution-produced rating sites were also analyzed. Findings were stratified between academic vs nonacademic and arthroplasty vs nonarthroplasty surgeons. Five hundred and six staff surgeons across 10 academic and nonacademic affiliated hospitals yielded 27,792 patient-generated ratings and reviews for 1404 accounts.

RESULTS

Features on all sites were practice location, languages spoken, and patient experience. Two sites autogenerated profiles of surgeons without consent. No physician-rating site contained all Consensus Core domains. The composite orthopedic surgeon rating was 4.1 of 5. No significant differences were found between academic and nonacademic affiliated surgeons. Arthroplasty surgeons had a greater number of reviews and ratings on 2 sites.

CONCLUSION

Reliability of physician-rating sites is questionable, as none contained all Consensus Core domains. Autogeneration of surgeon profiles is occurring, and no differences between academic vs nonacademic or arthroplasty vs nonarthroplasty surgeons were found. Institution-produced sites may serve to better promote and market surgeons.

Exploring the factors that influence medication rating Web sites value to older adults: A cross-sectional study

In this cross-sectional study, we evaluated factors that affected the perceived value of medication rating Web sites to 284 people aged ≥ 60 years who were taking prescription medications. The Patient Reviews of Medication Experience (PROMEX) questionnaire score, which assessed participant opinions about the value of online reviews of medications, was positively associated with preference to share health care decision making with the health care provider and negatively associated with the Physical Component Summary (PCS-12) and Mental Component Summary scores of the Short Form 12 health survey. The Primary Care Assessment Survey Communication score, which measured participant satisfaction with the communication from the health care provider, was positively associated with PCS-12 and health literacy. In summary, older adults who had poor physical and mental health-related quality of life were more likely to believe that medication rating Web sites were useful and helpful in facilitating communication with health care providers.

Governance mechanisms in the physician-patient relationship: a literature review and conceptual framework

BACKGROUND

The physician-patient relationship is a critical component of the integrated approach to excellence in health-care delivery. Although commonly modelled within the boundaries of the agency theory and regarded as synonymous to an agent-principal interaction, there exists only a sparse understanding about the most effective ways of governing it.

OBJECTIVE

This article undertakes a selective review of the growing body of research on the governance of the physician-patient relationship to discuss the current state of the knowledge in the field and suggest promising avenues for further exploration.

FINDINGS

On the basis of an extensive analysis of the relevant literature, we identify two emerging streams of inquiry on the trust-based (i.e. trust and ethical oversight) and distrust-based (i.e. patient information-empowerment and decision-making authority) governance mechanisms of the physician-patient relationship and discuss the key findings within each stream.

DISCUSSION

To conciliate the on-going scholarly debate concerning the efficacy of trust- and distrust-based mechanisms, we draw the foundations of a conceptual framework which might serve as a guide for more integrative research endeavours on the governance of the physician-patient relationship.

Analysis of 4999 online physician ratings indicates that most patients give physicians a favorable rating

BACKGROUND

Many online physician-rating sites provide patients with information about physicians and allow patients to rate physicians. Understanding what information is available is important given that patients may use this information to choose a physician.

OBJECTIVES

The goals of this study were to (1) determine the most frequently visited physician-rating websites with user-generated content, (2) evaluate the available information on these websites, and (3) analyze 4999 individual online ratings of physicians.

METHODS

On October 1, 2010, using Google Trends we identified the 10 most frequently visited online physician-rating sites with user-generated content. We then studied each site to evaluate the available information (eg, board certification, years in practice), the types of rating scales (eg, 1-5, 1-4, 1-100), and dimensions of care (eg, recommend to a friend, waiting room time) used to rate physicians. We analyzed data from 4999 selected physician ratings without identifiers to assess how physicians are rated online.

RESULTS

The 10 most commonly visited websites with user-generated content were HealthGrades.com, Vitals.com, Yelp.com, YP.com, RevolutionHealth.com, RateMD.com, Angieslist.com, Checkbook.org, Kudzu.com, and ZocDoc.com. A total of 35 different dimensions of care were rated by patients in the websites, with a median of 4.5 (mean 4.9, SD 2.8, range 1-9) questions per site. Depending on the scale used for each physician-rating website, the average rating was 77 out of 100 for sites using a 100-point scale (SD 11, median 76, range 33-100), 3.84 out of 5 (77%) for sites using a 5-point scale (SD 0.98, median 4, range 1-5), and 3.1 out of 4 (78%) for sites using a 4-point scale (SD 0.72, median 3, range 1-4). The percentage of reviews rated ≥75 on a 100-point scale was 61.5% (246/400), ≥4 on a 5-point scale was 57.74% (2078/3599), and ≥3 on a 4-point scale was 74.0% (740/1000). The patient's single overall rating of the physician correlated with the other dimensions of care that were rated by patients for the same physician (Pearson correlation, r = .73, P < .001).

CONCLUSIONS

Most patients give physicians a favorable rating on online physician-rating sites. A single overall rating to evaluate physicians may be sufficient to assess a patient's opinion of the physician. The optimal content and rating method that is useful to patients when visiting online physician-rating sites deserves further study. Conducting a qualitative analysis to compare the quantitative ratings would help validate the rating instruments used to evaluate physicians.

The effects of a computer-tailored message on secondary prevention in type 2 diabetes: a randomized trial

The purpose of this study was to test the effect of computer-generated, tailored feedback on the quality of chronic disease management for type 2 diabetes when provided to a patient prior to a scheduled physician visit. A stand-alone computer application was developed to provide tailored feedback aimed at empowering patients to engage more actively in their diabetes management. Adults with type 2 diabetes (n = 203) were randomly assigned to groups receiving either efficacy (positive) messages (n = 68), risk (negative) messages (n = 67), or to a delayed treatment control group (n = 68). The intervention was delivered prior to a patient's visit with his or her physician so that patients would have the opportunity to discuss the messages at the clinical appointment. Although there were no significant differences in the percentage of participants who received intensified care or routine tests between the control and intervention groups, we learned that more directive messaging may be needed to help patients effectively manage their diabetes. Patients may benefit from directive feedback, providing them with specific questions to ask their physician that can lead to improved care, rather than receiving general and educational informational messages.

Use of and satisfaction with sources of health information among older Internet users and nonusers

PURPOSE

Older adults generally have an increased need for health care information. Whereas some use the Internet to look for this information, others use more traditional sources. This study gathered data from older adults to determine their health information needs, the perceived usefulness of sources of health information, and if there are differences in perceptions and use of health information between Internet users and nonusers.

DESIGN AND METHODS

We conducted 9 focus groups-4 groups of Internet users (n = 27) and 5 groups of non-Internet users (n = 26)-to determine reasons for seeking health information, satisfaction with information, and use of the Internet to fulfill information needs. Data from focus groups were supplemented with questionnaire data.

RESULTS

Those who do not use the Internet were found to be just as satisfied with the health information they find as those who search for information online. We also found that nonusers are more likely to make health care decisions based upon information found offline than Internet users who have access to more information.

IMPLICATIONS

Nonusers may find it quicker to look for information through traditional media sources and stay offline, thus limiting their information options. Strategies for encouraging Internet use and programs to teach effective searching skills are needed. Physicians could also direct older patients toward credible health information Web sites.

The physician-patient relationship: the impact of patient-obtained medical information

We investigate the impact of patient-obtained medical information (POMI) on the physician-patient relationship when patients, as a group, are heterogeneously informed and a physician's interests do not coincide with those of her patients. Introducing additional well-informed patients to the population discontinuously affects the physician's strategy, having no effect unless a sufficient quantity is added. When few patients are well informed, increasing the precision of their information level has no effect on the physician's strategy. Alternately, when a sufficient number of well-informed patients exists, increasing the precision of their information allows all patients to free-ride by receiving more appropriate treatment recommendations.Counterintuitively, we also identify circumstances under which increasing the general level of information may potentially harm patients.

What is missing on their web sites? An evaluation of national and international pharmaceutical companies in Turkey

The Turkish Pharmaceutical Manufacturers Association-Ilaç Endüstrisi Isverenler Sendikasi (IEIS) set guidelines for pharmaceutical companies when designing their websites in 2003. The objective of this study is to evaluate whether pharmaceutical company websites comply with these guidelines. The list of all the national and international pharmaceutical companies active in Turkey is obtained from Farmalist Vademecum. We evaluated each site in terms of availability of drug advertisement, mail address, e-mail address, telephone number, fax number, update information, indication of target group, links, references, information, appropriate content for the intended target group, disclaimer stating the given information is only for health care professionals, disclaimer stating the given information cannot replace a health care professional, responsible body for the website design. The search was done throughout February 2005. We used x(2) test and Fisher's exact x(2) tests for statistical analysis. Of the 82 pharmaceutical companies active in Turkey, 51 had a website eligible for evaluation. Of the 51 companies, 34 (66.7%) were national and 17 (33.3%) were international. Eighteen companies had drug advertisement on the home page of their websites (64.7%). Of the total companies majority had mail address (89.2%); telephone number (89.2%); fax number (84.3%); links (66.7%); and appropriate content for the health care professionals (62.7%). The frequency of having update information and a separate pharmacist/physician information part was higher among international pharmaceutical company websites compared to the national ones. These differences were statistically significant (p < 0.05). As a result of the evaluation, the majority of the pharmaceutical companies failed to comply wholly with the guidelines set by IEIS when designing their website on the Internet.

Brief report: What types of Internet guidance do patients want from their physicians?

OBJECTIVES

To understand what patients expect from physicians regarding information seeking on the Internet.

DESIGN

Self-administered survey.

SETTING/PARTICIPANTS

Waiting rooms of 4 community-based primary care offices.

MEASUREMENTS/MAIN RESULTS

Of 494 patients invited to participate, 330 completed the survey for a response rate of 67%. Of 177 respondents who used the Internet for health information, only 15% agreed that physicians should ask them about their Internet searches. Most (62%) agreed that physicians should recommend specific web sites where patients can learn more about their health care.

CONCLUSIONS

Primary care physicians should recognize that many patients would like guidance as they turn to the Internet for medical information. Physicians can utilize quality assessment tools and existing resources that facilitate referring patients to authoritative, commercial-free, patient-oriented medical information on the Internet.

The effect of web-based, personalized, osteoarthritis quality improvement feedback on patient satisfaction with osteoarthritis care

To address gaps in the quality of care for osteo-arthritis, the authors developed a Web-based computer program to provide patients with personalized feedback designed to improve the quality of their osteoarthritis care. The current study was designed to examine satisfaction as well as the potential effects of the feedback on patients' perceptions of their osteoarthritis care by randomizing patients to use the site before or after they answered questions about the quality of their osteoarthritis care. On average, participants received 8.7 recommendations to change their osteoarthritis care. Satisfaction with osteo-arthritis care was similar between subjects in both groups. Most subjects believed that the Web site would help them get better care from their doctor (77.7%), and most would recommend it to others (94.3%). Overall, the Web site is well accepted and has no negative effect on patients' satisfaction with their osteo-arthritis care.