6-005-1430-Rosenmann
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  • About third of orthopedic surgeons in Israel.
  • Only surgeons who attended the meeting and agreed to participate were recruited; probably these are more internet-literated and cooperative.

Transcript

  • 1. Orthopedic Surgeons Are Willing to Provide an “Internet Prescription” Lena Rosenmann, Roger Sevi, Omer Or, Itzhak Gur, Yoav Mattan, Leonid Kandel Hadassah Medical Center Jerusalem, Israel
  • 2. Financial Disclosure - None
  • 3. Introduction
    • In the Western world, Internet use is still growing
    • Health information is one of the most common
    • Health information presence in Internet and attitude towards it widens, takes different forms and elaborates
    • Up to 80% of Internet users look for health information
    • Pew Research Center
  • 4. When a Patient Looks for Health Information on Internet
    • It may have an influence on:
    • Level of information or disinformation
    • Delicate physician-patient relationship
    • Physician authority
    • Patient anxiety and disease control perception
    • Patient compliance
    • Unnecessary diagnostics and treatment choices
    • and…
    • Even maybe general health outcome
  • 5. “ Internet Prescription”
    • First introduced by Gerber and Eiser,
    • 2001, J Med Int Res
    • Gives a patient:
    • Physician-approved source of information
    • Not a “real” internet information – filtered one
    • In utopic world – the best source of information
    • Is it so in the real world?
  • 6. Physician Attitude
    • Very little is written on physicians’ attitude
    • Most of literature is 10 years old
    • Gerber, J Med Int Res, 2001
    • Potts, J Med Int Res, 2002
    • Murray, J Med Int Res, 2003
    • Qualitative studies
    • Limited medical areas (mostly primary care)
  • 7. Orthopedic Surgeons and Internet
    • We conducted this study to assess orthopedic surgeons’ attitude to internet use by their patients in a Western world country
    • This study is continued by similar study on the internet use habits of orthopedic patients in the same country.
  • 8. Why orthopedic (musculoskeletal) medicine?
    • Up to 20-25% of visits to primary care physicians
    • Up to 40% of visits to emergency department
    • Mix of acute and chronic diseases
  • 9. However…
    • The audience should be aware that an orthopedic surgeon is…
  • 10. Strong as an ox and twice as smart
  • 11. Materials and methods
    • Survey among orthopedic surgeons
    • A questionnaire was administered to orthopedic surgeons, both board-certified and residents, during an annual National Orthopedic Association meeting.
    • The surgeons were aggressively urged to fill it.
  • 12. Materials and methods
    • Questionnaire:
    • - Demographic data – age, years in practice
    • - 12 closed questions:
  • 13. Questions - general
    • How many of your patients search internet?
    • Do you propose “internet prescription”?
    • What do you think about Internet data quality in your field
  • 14. Questions – physician-patient relationship
    • Compromise of physician authority
    • Changes in physician-patient relationship
    • Unnecessary tests and interventions
  • 15. Questions – patient
    • Disease control perception
    • Compliance with treatment
    • Final health outcome
  • 16. Questions
    • Do you think that the National Orthopedic Association should construct an internet site with reliable and up to date information for patients (that will serve as an “internet prescription”)?
    • Would you like to take a part in building this site?
  • 17. Results
    • 201 participants
    • 62 residents, mean age 35±4 years
    • 139 certified surgeons, mean age 51±9 years, 12±10 years after the board exams
  • 18. Results
  • 19. Results
  • 20. Results – “internet prescription”
    • Middle-aged surgeons (between 6 and 20 years in practice) referred patients to internet more than residents and young surgeons and then older surgeons.
    • This difference was statistically significant
  • 21. Results
  • 22. Results
    • Internet does not jeopardize:
    • Physician authority – 71%
    • Doctor-patient relationship - 77%
    • Patient's control perception - 91%
    • Compliance - 84%
  • 23. Results
    • Internet improves:
    • Doctor-patient relationship - 50%
    • Patient's control perception - 64%
    • Compliance - 44%
  • 24. Results
    • 74% of surgeons were concerned that internet-educated patients are exposed to unnecessary tests and interventions.
  • 25. Results
    • Surprisingly, there was no statistically significant correlation between age and years in practice and any other variable (except internet prescription)
  • 26. Results
    • 90% of surgeons wanted the National Orthopaedic Association to develop a site that can serve as an "internet prescription" for patients' referral.
    • 45% agreed to participate in this project
    • However only small minority supplied their connecting details.
  • 27. Discussion
    • In 2002, only 2% of UK physicians thought that their patients search the web
    • Potts, J Med Int Res, 2002
    • In 2003, 60% of US physicians felt that less then 20% of patients search the web
    • Murray, J Med Int Res, 2003
  • 28. Discussion
    • In 2010, survey among Dutch physicians showed similar results to our study – more than 80% of physicians state that their patients search the web.
    • van Uden-Kraan, Clin Rheum, 2010
    • Thus, it seems that comparison to older studies is irrelevant.
  • 29. Discussion
    • But is it really so, or physicians are too optimistic?
    • In our next study: only 32% of orthopedic patients in the same country searched the web for their current medical condition
  • 30. Internet prescription
    • Middle aged surgeons
    • Have more time than residents and young surgeons
    • More computer-friendly than older surgeons
    • Still need advertisement to recruit new patients – develop personal sites
  • 31. Internet prescription
    • Was more common in our study
    • In Dutch study, 74% of physicians never or seldom referred patients to Internet.
    • van Uden-Kraan, Clin Rheum, 2010
    • In our study, only 45% never or seldom referred
    • In Dutch study, female physicians referred more often
  • 32. Orthopedic surgeons are still mainly males Thus, the difference even more significant
  • 33. Our study Dutch study Undermines authority 30% 31% Damages physician-patient relationship 13 % 23% Improves patient’s control perception 64 % 75 % Unnecessary treatments and diagnostic tests 74% Test 91% Treatment 75%
  • 34. Study limitations
    • Recruitement bias – participating surgeons are probably more internet-literate
    • Country of immigrants (as most of Western world countries) – different languages between surgeons and patients – influence the attitude of surgeons to quality of data, that could me mistake
  • 35. Conclusions
    • Orthopedic surgeons are ready for the internet, do not feel threatened and feel that the quality of data is reasonable
    • However, they concerned about unnecessary diagnostic tests and treatments
  • 36. Conclusions
    • Most of surgeons provide their patients with an “internet prescription”
    • National Orthopedic Association should be responsible for building and updating a reliable source of internet information for patients
  • 37. Conclusions
    • This study results are very optimistic
    • However, our next study puts them in question (from the patients’ point of view)
  • 38. Thank you