Orthopedic Surgeons Are Willing to Provide an “Internet Prescription” Lena Rosenmann, Roger Sevi, Omer Or, Itzhak Gur, Yoa...
Financial Disclosure - None
Introduction <ul><li>In the Western world, Internet use is still growing </li></ul><ul><li>Health information is one of th...
When a Patient Looks for Health Information on Internet <ul><li>It may have an influence on: </li></ul><ul><li>Level of in...
“ Internet Prescription” <ul><li>First introduced by Gerber and Eiser, </li></ul><ul><li>2001, J Med Int Res </li></ul><ul...
Physician Attitude <ul><li>Very little is written on physicians’ attitude </li></ul><ul><li>Most of literature is 10 years...
Orthopedic Surgeons and Internet <ul><li>We conducted this study to assess orthopedic surgeons’ attitude to internet use b...
Why orthopedic (musculoskeletal) medicine? <ul><li>Up to 20-25% of visits to primary care physicians </li></ul><ul><li>Up ...
However… <ul><li>The audience should be aware that an orthopedic surgeon is… </li></ul>
Strong as an ox and twice as smart
Materials and methods <ul><li>Survey among orthopedic surgeons </li></ul><ul><li>A questionnaire was administered to ortho...
Materials and methods <ul><li>Questionnaire: </li></ul><ul><li>- Demographic data – age, years in practice </li></ul><ul><...
Questions - general <ul><li>How many of your patients search internet? </li></ul><ul><li>Do you propose “internet prescrip...
Questions – physician-patient relationship <ul><li>Compromise of physician authority </li></ul><ul><li>Changes in physicia...
Questions – patient <ul><li>Disease control perception </li></ul><ul><li>Compliance with treatment </li></ul><ul><li>Final...
Questions <ul><li>Do you think that the National Orthopedic Association should construct an internet site with reliable an...
Results <ul><li>201 participants </li></ul><ul><li>62 residents, mean age 35±4 years </li></ul><ul><li>139 certified surge...
Results
Results
Results – “internet prescription” <ul><li>Middle-aged surgeons (between 6 and 20 years in practice) referred patients to i...
Results
Results <ul><li>Internet does not jeopardize: </li></ul><ul><li>Physician authority –  71% </li></ul><ul><li>Doctor-patien...
Results <ul><li>Internet improves: </li></ul><ul><li>Doctor-patient relationship - 50%  </li></ul><ul><li>Patient's contro...
Results <ul><li>74% of surgeons were concerned that internet-educated patients are exposed to unnecessary tests and interv...
Results <ul><li>Surprisingly, there was no statistically significant correlation between age and years in practice and any...
Results <ul><li>90% of surgeons wanted the National Orthopaedic Association to develop a site that can serve as an &quot;i...
Discussion <ul><li>In 2002, only 2% of UK physicians thought that their patients search the web </li></ul><ul><li>Potts, J...
Discussion <ul><li>In 2010, survey among Dutch physicians showed similar results to our study – more than 80% of physician...
Discussion <ul><li>But is it really so, or physicians are too optimistic? </li></ul><ul><li>In our next study: only 32% of...
Internet prescription <ul><li>Middle aged surgeons </li></ul><ul><li>Have more time than residents and young surgeons </li...
Internet prescription <ul><li>Was more common in our study </li></ul><ul><li>In Dutch study, 74% of physicians never or se...
Orthopedic surgeons are still mainly males Thus, the difference even more significant
Our study Dutch study Undermines authority 30% 31% Damages physician-patient relationship 13 % 23% Improves patient’s cont...
Study limitations <ul><li>Recruitement bias – participating surgeons are probably more internet-literate </li></ul><ul><li...
Conclusions <ul><li>Orthopedic surgeons are ready for the internet, do not feel threatened and feel that the quality of da...
Conclusions <ul><li>Most of surgeons provide their patients with an “internet prescription” </li></ul><ul><li>National Ort...
Conclusions <ul><li>This study results are very optimistic </li></ul><ul><li>However, our next study puts them in question...
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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.
  • 6-005-1430-Rosenmann

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

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