Original Article

Patients and the Internet: A demographic study of a cohort of orthopaedic out-patients

A.C. Jariwala, M.S. Kandasamy, R.J. Abboud and C.A. Wigderowitz
Department of Trauma and Orthopaedic Surgery, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY

Correspondence to: C.A. Wigderowitz, Department of Trauma and Orthopaedic Surgery, TORT Centre, Ninewells Hospital, Dundee, DD1 9SY

Introduction Materials and methods Results

Discussion References

The Internet is a rich source of medical information but relatively few studies have evaluated its use by patients who seek medical information. The purpose of this study is to assess the demographics of Internet access and attitudes towards the Internet in a cohort of orthopaedic out-patients. Four hundred and three patients attending the orthopaedic outpatient fracture clinic completed a questionnaire consisting of six divisions including personal information, facility to access the Internet and their attitudes towards the information retrieved. Fifty per cent of the patients accessed the Internet, either from home or office and the maximum usage being in the younger age group. Twenty-nine per cent of the patients were aware of the medical information available through the Internet. 19% patients would like to have a consultation through the Internet, the maximum being in the middle-aged group. 70% of those patients who accessed the medical information reported that the Internet information was different than that obtained at consultation with the doctor at the out-patient clinic. This study reveals that the Internet use by patients is still limited. If an increased percentage of medical conditions is to be addressed through the Internet, involving patient information, on-line consultations, prescriptions and referrals, then a substantial amount of patient education and training is required

INTRODUCTION
The influence of the Internet on the doctorpatient relationship has been growing steadily.¹ Patients and doctors seek an increasing amount of information and many waiting areas are cluttered with leaflets regarding several conditions.² Nevertheless, a substantial number of problems still arise, because patients do not receive the appropriate information for their condition.³

All the existing sources of information must be explored to their full potential to maximise the availability of relevant information. To estimate the usefullness of the Internet as a patient information tool, it is essential to determine the ease of access and retrieve the necessary information. The aim of the current study was to gather information on the availability of the Internet to our patients and the ease of acquiring information without specific guidance. In addition, their opinion towards quality of the medical information in the Internet, their attitude towards possible Internet-based consultations and possible conflicts arising from two different sources of information was sought.

MATERIALS AND METHODS
This study was conducted by the Department of Orthopaedic and Trauma Surgery, University of Dundee at Ninewells hospital. Ethical approval was obtained from the Tayside Committee on Medical Research Ethics. Patients aged between 10 and 90 years, of both sex, attending the orthopaedic outpatient clinic between the period of 16 January to 1 February 2002 were considered for the study. Patients, who were younger than 10 years, and those not willing to volunteer for the study, were excluded. Those willing to participate were given the information sheet and the consent form along with the questionnaire to be completed. In total, 403 patients filled out and returned the questionnaire.

The questionnaire contained mostly closed answers with one final open question, and patients were asked to mark the most appropriate answer. The initial part of the questionnaire asked for demographic details, followed by the pattern of use of the Internet. In addition, the perception of patients regarding the content, amount and usefulness of medical information available over the web was sought. Patients were asked their views as to how the information offered by the consultant compared with that gathered from the Internet.

Figure 1: Shows the age distribution of the patients in the study independent of computer or the Internet use or other variables

RESULTS
The age distribution of the patients is illustrated in Figure 1 while the age-specific percentage of the Internet users is shown in Figure 2. The male (48%) to female (51%) numbers were comparable. Three patients failed to identify their gender in the questionnaire. The educational status of the patients is shown in Table 1. Almost all had a telephone at home with 4% of the patients using only mobile phones. Internet access was available to 50% and a large number of those who accessed the Internet did so daily, as demonstrated in Table 2. Awareness of the medical information available through the Internet is limited, 31.3% knew about where to retrieve specialised information. Among this latter group, 8.2% were aware through friends, 9.7% through relatives and 13.4% through self-browsing. Nearly 70% of patients who accessed the Internet did not receive from it any medical information. Out of those who received medical information, only 10% obtained information relevant to their orthopaedic problem. Table 3 shows the opinion of the patients regarding the quality of information, their awareness and willingness for the Internet consultation. The patients’ response to having pre-consultation Internet information is presented in Table 4, which also depicts the difference in the information received from the Internet and their consultations along with their respective perceptions regarding it.

Figure 2: Illustrates the age distribution of the Internet using patients

DISCUSSION
The most striking observation of this study is the relatively limited number of patients in Dundee who have access to the Internet. In addition, younger patients seem to have a higher level of Internet usage and greater awareness of the information available than the elderly. On the other hand, adults between thirty one to fifty years were the most eager to have Internet consultations.

Our results agree with those obtained in a London district hospital, where 56% of patients used the Internet, suggesting that there might not be a significant geographical variation within the United Kingdom.¹ Wright et al. (2001) also found that only 8.29% of UK patients accessed Internet for health reasons.² The implications of these studies is that the Internet is probably not yet well established and readily available to substitute more conventional ways of communication, especially regarding health issues. This in turn also affects the potential use of the Internet as a tool for monitoring follow-up of treatment, educating the patients and suggesting treatment protocols, as only a relatively small number of patients would be helped. Although, we did not specifically address this issue, one wonders if the effect and the expense of building specific websites would be cost effective for such a small fraction of patients.

  In contrast to the findings above, the percentage (29%) of patients that actually are aware of Internet information in Dundee seems substantially smaller than in London, where Gupte et al. (2001) found that 52% of the patients had knowledge of this specific information.¹ In addition, whereas only 19% of the interviewed patients preferred to have Internet consultation in the present study, 36% of those in London would choose an Internet consultation.¹ The reasons for these differences are not clear, although they may reflect differences in life style. The ability to choose the time and duration of Internet consultations may add to its attractions.

Only 10% of patients had effectively obtained information related to their problem and even fewer commented upon the quality of this information. Seventy per cent of those who obtained medical information reported that the information received from the Internet was different from the treatment proposed by the doctor, whereas in Gupte’s study only 20% patients found a difference in the treatment proposed by the doctor and that proposed on the Internet. 1 It is important to investigate where these discrepancies arise from as they may lead to confusion and increased difficulty in the medicalpatient relationship. It seems also relevant to think of possible ways of dealing with this type of conflict, although specific recommendations are beyond the scope of the present work. Before increasing the number of medical conditions to be addressed through the Internet, involving patient information, on-line consultations, prescriptions and referrals, a substantial amount of patient education and training is likely to be necessary.⁵ Further studies, including the creation and evaluation of specific education programmes, to increase Internet awareness and usage would be extremely useful.

REFERENCES
1. Gupte CM, Hassan ANA, McDermott ID, Thomas RD. Orthopaedic Patients and the Internet- Friend or Foe? A Cross-Sectional Survey. British Orthopaedics Research Society. BORS Meeting 2001, (9).
2. Lindberg DAB. The National Library of Medicine’s Website for Physicians and Patients. JAMA 2001 285; 6: 806.
3. Silberg WM, Lundberg GD, Musacchio RA. Assessing, Controlling and Assuring the Quality of Medical Information on the Internet. JAMA 1997 277: 15; 1244-45.
4. Wright JED, Brown RR, Chadwick C, Karadaglis D. The Use Of The Internet By Orthopaedic Outpatients: J Bone Joint Surg (Br) 2001 83-B; 8: 1096-97.
5. Grover Jr. F, Wu HD, Blanford C, Holcomb S, Tidler D. Computer-using patients want Internet services from family physicians. J Fam Prac 2002 51; 6: 570-72.

Copyright: 2 February 2004