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Medical text-based consultations on the Internet: a 4-year study.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Family Medicine.
2008 (English)In: International Journal of Medical Informatics, ISSN 1386-5056, 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.

Place, publisher, year, edition, pages
2008. Vol. 77, no 2, 114-121 p.
Keyword [en]
Access to Information, Adolescent, Adult, Female, Humans, Internet, Longitudinal Studies, Male, Medical Informatics, Middle Aged, Physician-Patient Relations, Remote Consultation/*utilization, Sweden
URN: urn:nbn:se:umu:diva-10168DOI: 10.1016/j.ijmedinf.2007.01.009PubMedID: 17317292OAI: diva2:149839
Available from: 2008-06-25 Created: 2008-06-25 Last updated: 2009-10-30Bibliographically approved
In thesis
1. Internet consultation in medicine: studies of a text-based Ask the doctor service
Open this publication in new window or tab >>Internet consultation in medicine: studies of a text-based Ask the doctor service
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.
Umeå University medical dissertations, ISSN 0346-6612 ; 1034
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
urn:nbn:se:umu:diva-854 (URN)91-7264-123-1 (ISBN)
Public defence
2006-10-06, Hörsal Betula, 6M, UMEÅ, 10:00 (English)
Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2016-05-26Bibliographically approved

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