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Volume: 7 Issue: 4 December 2009

FULL TEXT

The Internet as a Tool For Patient-centered Care in Transplantation

The Internet is a popular communication tool that plays a significant role in patient-centered care. It is argued that a driving force for the demand for on-line health information is the paucity of information easily obtained from traditional channels. As the quality of medical information available on the Internet is variable, and the quantity is constantly increasing and changing, there is a need for rigorous assessment of quality and effectiveness of health Web sites, and the Internet-based health care support services for different fields of medicine. On one hand, Internet-based patient support tools and Web sites have been used successfully in managing patient’s with different illnesses like lung transplant, vascular surgery, and treating diabetes mellitus—but on the other hand, other studies have shown that a majority of Web sites providing information on kidney and liver transplant are of poor quality and need overhauling. In the modern world, where e-technology has become common place, patients deserve e-services that are informative, trustworthy, and useful. It is not only a challenge, but also the responsibility of clinicians to make this happen.


Key words : Transplant patient, Web sites, Online health management

Patient-centered care is defined as health care that establishes a partnership between practitioners, patients, and their families to ensure that decisions made respect the patient’s wants, needs, and preferences; and that patients have the education, authority, and support they need in making decisions and participating in their own care (1).

The Internet is a popular communication tool that plays a role in patient-centered care. It has enabled clinicians to readily access health information, with the potential to substantially influence relations between patients and health professionals. For example, by evolving from the traditional model of the doctor-administered advice and doctor-administered medications (associated with variable levels of patient understanding and adherence) to one of shared decision-making (2).

When free, public access was opened, the number of Medline searches performed by directly accessing the database at the National Library of Medicine increased from 7 million in 1996 to 120 million in 1997. The new searches are attributed primarily to nonprofessionals (3). It has been argued that a driving force behind demand for on-line health information is the shortage of information easily obtained from traditional channels (4). With the duration of an average consultation still only 12 minutes in the United States and 7 minutes in the United Kingdom, it is perhaps not surprising that professionals routinely fail to address the information needs of consumers (5).

As the quality of medical information available on the Internet is variable, and the quantity is constantly increasing and changing (6-8), there is a need for rigorous assessment of the quality and effectiveness of health-centered Web sites, and the Internet-based, health-care support services for different fields of medicine.

At a study done in a German cardiovascular center (7), lung transplant patients were equipped with telemetric monitoring devices, consisting of a portable flowmeter and a special modem unit (9). The flowmeters measured forced vital capacity, forced expiratory volume per second, and mid expiratory flows, and encoded information about clinical symptoms (for example, fever, cough, and breathlessness) in a binary code. After using the flowmeter, patients used the modem unit to transfer the data to a central computer at the hospital. In a mean follow-up of 10.3 ± 2.2 months, 15 episodes of significant deterioration in home pulmonary function tests (> 10%) were registered in 6 patients, and these were all confirmed by in-hospital body plethysmography. These 15 episodes resulted in diagnoses of 4 instances of acute rejection, 6 of early bacterial pneumonia, and 5 of tracheobronchitis. Of the sixth day, only 1 patient had to be admitted to the hospital; the rest were treated on an out-patient basis.

The Vascular Unit in Oxford, United Kingdom, published the outcome of their study of patients with vascular symptoms who were managed with a teleclinic after being referred by their general practitioner (10). Thirty-seven patients, aged 30 and 93 years (median, 72), were enrolled in the teleclinic, which included assessment by a practice nurse and a teleconference, between March 2001 and July 2004. Of these, 12 had leg ulcerations, 12 complained of leg pain, and the remainder had a range of symptoms—potentially vascular in nature. All patients had an initial teleconsultation that lasted a median of 11 minutes (interquartile range, 9 min 59 s to 12 min
43 s). For 10 of the patients, this was their only contact with the hospital. Of the remainder, 1 patient had a single teleconsultation follow-up, and the other 26 patients attended the hospital for vascular laboratory studies or angiography. Eight of these latter patients went on to have radiologic and/or surgical intervention. For follow-up, only 3 patients attended the outpatient department; all other follow-ups were managed via the teleclinic. Overall, 57 standard, outpatient attendances in these patients were replaced by teleconsultations.

Kwon and associates developed a blood glucose management system using the Internet and short message service (11). A total of 185 diabetic patients participated in this study; their mean age was 42.4 years. Participants sent their self-measured blood glucose levels, medication, and its dosages; amount of the meal; and degree of exercise to their health providers in this specialized Web-based diabetes management system for 3 months. The health providers consisting of endocrinology specialists, dieticians, and nurses sent recommendations for individualized diabetes management according to the data on the Web. The mean Hb A1c improved from 7.5% ± 1.5% to 7.0% ± 1.1% after using the management program (P = .003). Moreover, mean serum triglyceride and HDL-cholesterol levels also showed significant improvement.

On the other end of spectrum, in 2 separate studies, we demonstrated that the quality of information on liver (12) and kidney transplant (13) on the Internet is poor, and that the Web sites are in a need of overhauling input from clinicians to improving the quality of contents and presentation (Table 1). We used a weighted information scoring system to assess the quality of Web sites. In both studies, European transplant Web sites produced numerically higher score as compared with the United States, but this difference was not statistically significant; in both types, though, academic Web sites were the best (12, 13).

Although the Internet’s power to positively affect care management seems intuitive, its value for improving health outcomes must be examined and documented to provide a basis for further advancement in different fields of medicine. The question for future research is: Can the Internet, by providing health support through purpose, build Web sites, E-mail, and telemedicine reduce primary and secondary health care referrals in different fields of medicine including organ transplant? In the modern world, where e-technology is common place, patients deserve e-services which are informative, trustworthy, and useful. It is not only a challenge to, but also a responsibility, of clinicians to make this happen.


References:

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  9. Wagner FM, Weber A, Park JW, et al. New telemetric system for daily pulmonary function surveillance of lung transplant recipients. Ann Thorac Surg. 1999;68(6):2033-2038.
  10. Hands LJ, Clarke M, Mahaffey W, Francis H, Jones RW. An e-Health approach to managing vascular surgical patients. Telemed J E Health. 2006;12(6):672-680.
  11. Kwon HS, Cho JH, Kim HS, et al. Development of web-based diabetic patient management system using short message service (SMS). Diabetes Res Clin Pract. 2004;66(suppl 1):S133-S137.
  12. Hanif F, Sivaprakasam R, Butler A, et al. Information about liver transplantation on the World Wide Web. Med Inform Internet Med. 2006;31(3):153-160.
  13. Hanif F, Abayasekara K, Willcocks L, et al. The quality of information about kidney transplantation on the World Wide Web. Clin Transplant. 2007;21(3):371-376.


Volume : 7
Issue : 4
Pages : 225 - 227


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From the 1University Department of Surgery, Transplant Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
2Department of Computing, University of Central Lancashire, Preston
Acknowledgement: There are no conflict of interests including financial involved in this article, and it is not under consideration for publication in any other journal.
Address reprint requests to: Faisal Hanif, University Department of Surgery, Transplant Unit, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Phone: +44 1223 245 151
Fax: +44 1223 216 111
E-mail: fhanif@nhs.net