patient empowerment and the use of internet steinar pedersen
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Patient empowerment and the use of Internet
Steinar Pedersen
Ottawa Charter (WHO 1986)
• The idea of a process that enables people to ”increase control over, and to improve, their health”
• (Information therapy)
Patients and level of care
Personsper month Level of care
2 University hospital 13 Local hospital
150 GP
500 Self care
85 Symptoms, no treatment 250 No symptoms
1000 Population
Diagnosing the doctor-patient relationship
• Doctors do more talking than listening. One study found that 72% of the doctors interrupted the patient’s opening statement after an average of 23 seconds.
• And that doctors failed to elicit 54% of patients’ reasons for wanting a consultation and 45% of their worries.
• In one study of 20-minute office visits, doctors spent about 1 minute per visit informing patients, but believed they were spending 9 minutes per visit doing so.
Seaman summarizes • Doctors tend to perceive illness as a disease process that
can be measured and understood through laboratory tests and clinical observations. – To the patient, illness is a disrupted life.
• Doctor’s tend to focus more on keeping up with the rapid advances in medical science than on trying to understand the patient’s feelings and concerns. – Yet patient satisfaction comes primarily from a sense of being
heard and understood.
• Many doctors do not see the role of physician as listener, but instead view their function as: find it, and fix it. – Yet patients often feel devalued when their illness is reduced
to a mechanical process.
So the sharing of health issues with “strangers” may be a symptom of
dysfunctional doctor-patient
relationships.
The experience of discussing personal problems…
0
5
10
15
20
25
30
35
40
Serie1 24,4 36 29,9 6,5 3,2
Very easy Easy Medium Difficult Very difficult
0
5
10
15
20
25
30
35
40
Serie1 3,4 13,7 27,2 34 21,7
Very easy Easy Medium Difficult Very difficult
…on the Internet …face to face
• 75 percent find it easier to discuss personal problems in a discussion group online.• 46 percent claim they address issues online that they would not discuss otherwise.
Source: Kummervold et al. 2001
• Who would have guessed that passionate, intimate relationships would be established and maintained through hopelessly clumsy user interfaces like SMS and computers?
Health information and the Internet
19
31 28
15
2
51 5158
4740
9
28
47
3832
0
10
20
30
40
50
60
70
Total 15-29 30-44 45-59 60+
2000
2001
2002
%
Fox and Rainie (2002)
• Roughly 80% of the health seekers find the information they need on the Internett
Wanted e-Mail contact with the doctor
Alder
52
40
26
4
63
42
18
50
60
22
6359
0
10
20
30
40
50
60
70
80
15-29 30-44 45-59 60+
200020012002
• The physicians are today (reluctantly) accommodate patients wanting to interact electronically.
• But “If you can’t beat them, write them” may be the order of the day.
The new patient role• The well informed
patient• Empowerment• From “thank you” to
“why”• From passive recipient
to active participant• And they will use the
net!!!I’m sorry doctor, but again I have to disagree
Characteristics: The eHealth Consumer
• 1/3 of the population in Norway
• Higher education• Young adults• Higher income• Equal use among woman
and men
• The well-educated and well-off have access to and use the Internet to a much greater extent than those who are less well-educated and who are less well-off
Types of use
Discussion forums, self help groups
Questions to health personell
Information
Internet based self-help for breast cancer operated women
Preliminary results
• Available when they need it
• The net group has become their most important resource in their meeting with their own disease
• Bench marketing of the health care system
Effects on patients’ behaviour towards their doctors
N=476
Delayed, altered, or cancelled appointment
Scheduled new appointment
Attempted to decide own diagnosis
Posed more specific questions to their doctor
Effects on health consumers everyday self-care
N=476 (2001)
Change of diet or other lifestyle related behaviours
Experienced anxiety
Experienced relief
Heart patients
The Journal of the Norwegian Medical Association
• Results from a 14 articles meta- analysis show that the death rate is reduced with 30 %
• The main feature of the Internet is said to be its accessibility and interactivity
Key global telecom indicators
0
200
400
600
800
1000
1200
1992 2002
Main telephonelinesMobilesubscribersPCs
Internet users
Phone vs Internet
• In the UK, the Samaritans report that although only 20% of telephone callers report suicidal feelings, this number increases to around 50% of e-mail contacts.
• This phenomenon appears particularly relevant for those who feel stigmatised, shameful, and/or suffer from low self-esteem.
The use of Internet
0
500
1000
1500
2000
2500
3000
3500
Users/ 10.000
Africa (99)Americas (2421)Asia (558)Europe (2079)Oceania (3330)World (972)
Summary
• Knowledge is power, sharing is wisdom
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