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Internet consultation in medicine: studies of a text-based Ask the doctor service
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
2006 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to cast light on the new phenomenon of Internet-based medical consultation. This was approached by studies of the use of an Ask the doctor service, by a web survey to the users who sent enquiries to the service, and by a questionnaire to the answering physicians of their respective expericence of the service.

Written communication is becoming increasingly important, not only for communication between individuals outwith health care (e.g. by email, SMS and instant messaging), but also between doctors and patients. There is an ongoing shift in the way individuals look for medical information with an increasing number going first to the Internet berfore talking with their physicians. Also, there is an increasing interest from patients in accessing Internet-based services, including text-based consultations with doctors. These consultations can be part of the regular communication between a patient and his/her doctor or be carried out without any previous relationship. Our studies of the latter consultation type emanate from the free of charge Ask the doctor service at a Swedish public health web portal, Infomedica, financed by health authorities. At the Ask the doctor service, the communication has been merely text-based and the individual using the consultation service (here called the enquirer) might have been anonymous.

We followed the development of the first four years use of the service (38 217 enquiries), finding that the typical enquirer was a woman aged 21-60 years. Three quarters of the enquirers were women, thus exceeding the gender difference seen in regular health care. The service was used all times of the day and night, seven days a week, and it was most used in densely populated areas as defined from postal codes.

The enquiries submitted to the service included a broad variety of medical issues. Most enquirers asked on their own behalf. Almost half of the enquiries concerned a matter not previously evaluated by a medical professional. Only a few were frequent enquirers. The service was used e.g. for a primary evaluation of a medical problem, for getting more information on a medical issue under treatment, and for a second opinion. The most common reasons for turning to a doctor on the Internet were convenience, wish for anonymity and that doctors were experinced too busy. In free text a considerable number of participants expressed discontent and communication problems with a previous doctor as a reason to turn to the Ask the doctor service. Many participants expressed a view of the service as a complement to regular health care, and the majority were satisfied with the answer. Nearly half of the participants in the web survey stated that they received sufficient information in their answer and that they would not pursue their question further.

The family physicians answering the enquiries at the Ask the doctor service were stimulated and challenged by the new task, in spite of the limitations caused by the lack of personal meetings and physical examinations. The opportunity to reflect on the answer before replying was appreciated, and the task was regarded as having a high educational value for themselves.

The Internet not only allows easy access to medical information but also to medical consultation – to date mostly text-based. It is probable that in the near future an increasing number of doctors will adopt text-based communication via the Internet to be a natural part of their communication with patients. Therefore, training in text-based communication and carrying out Internet consultations should be integrated into the curricula of medical schools and of continuous professional development. Ethical guidelines should be established.

Place, publisher, year, edition, pages
Umeå: Umeå University , 2006. , 64 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1034
Keyword [en]
Internet, remote consultation, physician-patient relations, gender, access to information, ethics
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
medicinsk informatik
Identifiers
URN: urn:nbn:se:umu:diva-854ISBN: 91-7264-123-1 (print)OAI: oai:DiVA.org:umu-854DiVA: diva2:144744
Public defence
2006-10-06, Hörsal Betula, 6M, UMEÅ, 10:00 (English)
Opponent
Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2016-05-26Bibliographically approved
List of papers
1. Medical text-based consultations on the Internet: a 4-year study.
Open this publication in new window or tab >>Medical text-based consultations on the Internet: a 4-year study.
2008 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, E-ISSN 1872-8243, ISSN 1386-5056, Vol. 77, no 2, 114-121 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Internet is increasingly used for health matters including Ask the doctor services. AIM: To describe users and usage pattern of text-based medical consultation with family physicians on the Internet. METHODS: Descriptive analysis of the first 4 years' use of a Swedish Ask the doctor service concerning number of inquiries, age and gender of inquirers. Time of day and week, types of medical inquiries, and use in relation to population density was analyzed during the last year of the study. RESULTS: We found a considerable number of users, with 38,217 inquiries submitted to the service. Three-fourths of the inquirers were women, thus exceeding the gender difference seen in regular health care. The typical user was a woman aged 21-60 years. The service was used any time day or night, 7 days a week. Almost half of the inquiries were submitted during evenings and nights. Most areas of medicine were represented in the inquiries, reflecting the fact that there was no control of what an inquiry should include. The use was widespread over the country but more frequent per capita in more densely populated areas as defined by postal code. CONCLUSION: In the study of a service for text-based consultations with family physicians on the Internet, we found a geographically widely distributed use, slowly but gradually increasing during a 4-year period. The use increased more rapidly among young and middle-aged women. Asynchronous text-based consultation is likely to expand in the near future.

Keyword
Access to Information, Adolescent, Adult, Female, Humans, Internet, Longitudinal Studies, Male, Medical Informatics, Middle Aged, Physician-Patient Relations, Remote Consultation/*utilization, Sweden
Identifiers
urn:nbn:se:umu:diva-10168 (URN)10.1016/j.ijmedinf.2007.01.009 (DOI)17317292 (PubMedID)
Available from: 2008-06-25 Created: 2008-06-25 Last updated: 2017-12-14Bibliographically approved
2. The use of an internet-based ask the doctor service involving family physicians: evaluation by a web survey
Open this publication in new window or tab >>The use of an internet-based ask the doctor service involving family physicians: evaluation by a web survey
2006 (English)In: Family Practice, ISSN 0263-2136, E-ISSN 1460-2229, Vol. 23, no 2, 159-166 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Internet consultation without a previous relationship between the doctor and the enquirer seems to be increasing in popularity. However, little is known about the advantages, disadvantages or other differences compared with regular health care when using this kind of service. OBJECTIVE: To investigate how an Internet-based Ask the Doctor service out with any pre-existing doctor-patient relationship was used and evaluated by the enquirers. METHODS: We recruited to a web-based survey users of the non-commercial Swedish Internet-based Ask the Doctor service run by family physicians. The survey was conducted between November 2001 and January 2002. Questions included both multiple choice and free text formats, and the results were analysed quantitatively and qualitatively. RESULTS: The survey was completed by 1223 participants. It was mainly women who submitted questions to the service (29% men, 71% women) and also who participated in the survey (26% men, 74% women). Most participants (77%) wrote their question at home, and 80% asked on their own behalf. Almost half of the enquiries (45%) concerned a medical matter that had not been evaluated by a medical professional before. After reading the answer, 43% of the participants indicated that they would not pursue their question further having received sufficient information in the answer provided. The service was appreciated for its convenience and flexibility, but also for reasons to do with the mode of communication such as the ability to reflect on the written answer without having to hurry and to read it more than once. CONCLUSION: In the present study, we found that an Internet-based Ask the Doctor service run by family physicians on the whole was evaluated positively by the participants both in terms of the answers and the service. Internet-based consultation may act as a complement to regular health care. In future studies, the cost-effectiveness, patient security, responsibilities of the Internet doctor and the role of Ask the Doctor services compared with regular health care should be evaluated.

Keyword
Access to Information, Adolescent, Adult, Aged, Child, Data Collection, Female, Humans, Internet, Male, Middle Aged, Physician-Patient Relations, Physicians; Family, Remote Consultation/*utilization, Sweden
National Category
Family Medicine Other Medical Engineering Computer Science
Identifiers
urn:nbn:se:umu:diva-6319 (URN)10.1093/fampra/cmi117 (DOI)16464871 (PubMedID)
Available from: 2007-12-08 Created: 2007-12-08 Last updated: 2017-12-14Bibliographically approved
3. Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service
Open this publication in new window or tab >>Reasons for consulting a doctor on the Internet: Web survey of users of an Ask the Doctor service
2003 (English)In: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871, Vol. 5, no 4, e26- p.Article in journal (Other academic) Published
Abstract [en]

BACKGROUND: In 1998 the Swedish noncommercial public health service Infomedica opened an Ask the Doctor service on its Internet portal. At no charge, anyone with Internet access can use this service to ask questions about personal health-related and disease-related matters. OBJECTIVE: To study why individuals choose to consult previously-unknown doctors on the Internet. METHODS: Between November 1, 2001, and January 31, 2002 a Web survey of the 3622 Ask the Doctor service users, 1036 men (29%) and 2586 (71%) women, was conducted. We excluded 186 queries from users. The results are based on quantitative and qualitative analysis of the answers to the question "Why did you choose to ask a question at Infomedica's 'Ask the Doctor' service?" RESULTS: 1223 surveys were completed (response rate 36 %). Of the participants in the survey 322 (26%) were male and 901 (74%) female. As major reasons for choosing to consult previously-unknown doctors on the Internet participants indicated: convenience (52%), anonymity (36%), "doctors too busy" (21%), difficult to find time to visit a doctor (16%), difficulty to get an appointment (13%), feeling uncomfortable when seeing a doctor (9%), and not being able to afford a doctors' visit (3%). Further motives elicited through a qualitative analysis of free-text answers were: seeking a second opinion, discontent with previous doctors and a wish for a primary evaluation of a medical problem, asking embarrassing or sensitive questions, seeking information on behalf of relatives, preferring written communication, and (from responses by expatriates, travelers, and others) living far away from regular health care. CONCLUSIONS: We found that that an Internet based Ask the Doctor service is primarily consulted because it is convenient, but it may also be of value for individuals with needs that regular health care services have not been able to meet.

Keyword
Access to Information, Adolescent, Adult, Aged, Aged, 80 and over, Child, Confidentiality/trends, Delivery of Health Care/standards/trends, Female, Health Surveys, Humans, Information Services/trends, Internet/*trends, Male, Middle Aged, Patient Education as Topic/*trends, Public Health Informatics/trends, Remote Consultation/*trends, Sweden
National Category
Computer Science Family Medicine
Identifiers
urn:nbn:se:umu:diva-11107 (URN)10.2196/jmir.5.4.e26 (DOI)14713654 (PubMedID)
Available from: 2008-11-17 Created: 2008-11-17 Last updated: 2017-12-14Bibliographically approved
4. Primary care phycians’ experiences of carrying out consultations on the Internet
Open this publication in new window or tab >>Primary care phycians’ experiences of carrying out consultations on the Internet
Show others...
2004 (English)In: Informatics in Primary Care, ISSN 1476-0320, E-ISSN 1475-9985, Vol. 12, no 2, 85-90 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The internet is increasingly used for health matters, including consulting a doctor. Primary care physicians (general practitioners) will probably be involved in performing text-based consultations on the internet as a complement to physical meetings. In the present study, we explored the experiences of GPs already performing consultations on the internet: the challenges, worries and educational demands of the task. MATERIALS AND METHODS: A questionnaire was given to 21 GPs performing consultations on the internet for a public, non-commercial 'ask the doctor' service. The questionnaire was carried out at a meeting or sent by mail. The doctors answered a total of 28 questions, 12 of which included graded alternatives. RESULTS: The participating GPs were stimulated and challenged by performing consultations on the internet with previously unknown enquirers, in spite of limitations caused by the lack of personal meetings and physical examinations. The participants experienced a high educational value as a result of the problem-based learning situation induced by unfamiliar questions. The asynchronous feature was appreciated as it allowed time to reflect and perform relevant information searches before replying. Prior training and long-term experience as a family doctor were recommended before embarking on this method of consultation. CONCLUSIONS: We conclude that the GPs studied experienced their new role as internet doctors mainly in a positive way, with some limitations. With the increase in consultations on the internet, training in this technique should be integrated into the curricula of medical schools and of continuous professional development (CPD).

Keyword
information services, internet, remote consultation
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:umu:diva-5276 (URN)10.14236/jhi.v12i2.112 (DOI)15319060 (PubMedID)
Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2017-12-14Bibliographically approved

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