Transcript Nasjonalt senter for telemedisin

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)
Persons
per month
2
13
Patients
and level
of care
Level of care
University hospital
Local hospital
150
GP
500
Self care
85
250
Symptoms, no treatment
No symptoms
1000
Population
Diagnosing the doctorpatient 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…
…on the Internet
…face to face
40
40
35
35
30
30
25
25
20
20
15
15
10
10
5
5
0
Serie1
Very easy
24,4
Easy
36
Medium
29,9
Difficult
6,5
Very difficult
3,2
0
Serie1
Very easy
Easy
Medium
Difficult
Very difficult
3,4
13,7
27,2
34
21,7
• 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
70
58
60
51
50
40
30
20
32
51
47
47
40
38
31
28
19
28
15
10
9
2
% 0
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
80
70
60
60 59
52
50
63 63
40
40
50
42
26
30
18
20
10
22
4
0
15-29
Alder
30-44
45-59
60+
2000
2001
2002
• 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
I’m sorry doctor, but again I
have to disagree
• The well informed
patient
• Empowerment
• From “thank you” to
“why”
• From passive recipient
to active participant
• And they will use the
net!!!
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
Delayed, altered, or
cancelled
appointment
Scheduled new
appointment
Attempted to decide
own diagnosis
Posed more specific
questions to their
doctor
N=476
Effects on health consumers
everyday self-care
Change of diet or
other lifestyle related
behaviours
Experienced anxiety
Experienced relief
N=476 (2001)
Heart patients
The Journal of the Norwegian
Medical Association
• Results from a 14 articles metaanalysis 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
1200
1000
Main telephone
lines
Mobile
subscribers
PCs
800
600
400
Internet users
200
0
1992
2002
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
3500
3000
2500
Africa (99)
Americas (2421)
Asia (558)
Europe (2079)
Oceania (3330)
World (972)
2000
1500
1000
500
0
Users/10.000
Summary
• Knowledge is power, sharing is wisdom