Joseph A. Diaz

Patients' Use of the Internet for Medical Information

AbstractOBJECTIVES: To determine the percentage of patients enrolled in a primary care practice who use the Internet for health information, to describe the types of information sought, to evaluate patients’ perceptions of the quality of this information, and to determine if patients who use the Internet for health information discuss this with their doctors.n DESIGN: Self-administered mailed survey.n SETTING: Patients from a primary care internal medicine private practice.n PARTICIPANTS: Randomly selected patients (N=1,000) were mailed a confidential survey between December 1999 and March 2000. The response rate was 56.2%.n MEASUREMENTS AND MAIN RESULTS: Of the 512 patients who returned the survey, 53.5% (274) stated that they used the Internet for medical information. Those using the Internet for medical information were more educated (P<.001) and had higher incomes (P<.001). Respondents used the Internet for information on a broad range of medical topics. Sixty percent felt that the information on the Internet was the “same as” or “better than” information from their doctors. Of those using the Internet for health information, 59% did not discuss this information with their doctor. Neither gender, education level, nor age less than 60 years was associated with patients sharing their Web searches with their physicians. However, patients who discussed this information with their doctors rated the quality of information higher than those who did not share this information with their providers.n CONCLUSIONS: Primary care providers should recognize that patients are using the World Wide Web as a source of medical and health information and should be prepared to offer suggestions for Web-based health resources and to assist patients in evaluating the quality of medical information available on the Internet.

BRIEF REPORT: What Types of Internet Guidance Do Patients Want from Their Physicians?

AbstractOBJECTIVES: To understand what patients expect from physicians regarding information seeking on the Internet.n DESIGN: Self-administered survey.n SETTING/PARTICIPANTS: Waiting rooms of 4 community-based primary care offices.n MEASUREMENTS/MAIN RESULTS: Of 494 patients invited to participate, 330 completed the survey for a response rate of 67%. Of 177 respondents who used the Internet for health information, only 15% agreed that physicians should ask them about their Internet searches. Most (62%) agreed that physicians should recommend specific web sites where patients can learn more about their health care.n CONCLUSIONS: Primary care physicians should recognize that many patients would like guidance as they turn to the Internet for medical information. Physicians can utilize quality assessment tools and existing resources that facilitate referring patients to authoritative, commercial-free, patient-oriented medical information on the Internet.

Impact of Interpretation Method on Clinic Visit Length

AbstractOBJECTIVE: To determine the impact of interpretation method on outpatient visit length.n DESIGN: Time-motion study.n SETTING: Hospital-based outpatient teaching clinic.n PARTICIPANTS: Patients presenting for scheduled outpatient visits.n MEASUREMENTS AND MAIN RESULTS: Over a 6-week study period, a research assistant recorded the following information for consecutive patient visits: patient age, gender and insurance type; type of interpreter used (none, hospital interpreter, telephone interpreter or patient-supplied interpreter); scheduled visit length; provider type (nurse practitioner; attending physician; resident in postgraduate year 1, 2 or 3, or medical student); provider gender; amount of time the patient spent in the examination room with the provider (provider time); and total time the patient spent in the clinic from check-in to checkout (clinic time). When compared to patients not requiring an interpreter, patients using some form of interpreter had longer mean provider times (32.4 minutes [min] vs 28.0 min, P<.001) and clinic times (93.6 min vs 82.4 min, P=.002). Compared to patients not requiring an interpreter, patients using a telephone interpreter had significantly longer mean provider times (36.3 min vs 28.0 min, P < .001) and clinic times (99.9 min vs 82.4 min, P=.02). Similarly, patients using a patient-supplied interpreter had longer mean provider times (34.4 min vs 28.0 min, P<.001) and mean clinic times (92.8 min vs 82.4 min, P=.027). In contrast, patients using a hospital interpreter did not have significantly different mean provider times (26.8 min vs 28.0 min, P=.51) or mean clinic times (91.0 min vs 82.4 min, P=.16) than patients not requiring an interpreter.n CONCLUSION: In our setting, telephone and patient-supplied interpreters were associated with longer visit times, but full-time hospital interpreters were not.

Do internal medicine residents find pain medication agreements useful

Background Little is known about whether internal medicine residents find pain management agreements (PMAs) useful or whether PMA use is associated with more positive attitudes toward patients with chronic noncancer pain (CNCP). Methods We surveyed all internal medicine residents at Rhode Island Hospital regarding whether they found PMAs useful, what percentage of their patients taking chronic opioids had a signed PMA, and their attitudes toward and experiences with managing CNCP. Results Survey response rate was 89% (110/124). Ninety percent of respondents reported finding PMAs useful. A majority of respondents reported that PMAs were at least somewhat helpful for reducing multiple prescribers (76%), reducing requests for early refills (67%), reducing calls and pages from patients (57%), making it easier to discuss potential problems associated with chronic opioid use (73%), and making it easier to identify patients who are abusing pain medications (66%). Residents who reported greater use of PMAs reported a greater sense of preparation (r=0.20, P=0.04), greater confidence (r=0.18, P=0.06), and a greater sense of reward (r=0.24, P=0.02) for managing CNCP. In a multivariate analysis, PMA use was significantly associated with greater sense of preparation and greater sense of reward for managing CNCP. Conclusions Among internal medicine residents, PMA use was associated with more positive attitudes toward CNCP management.

Patient attitudes toward using computers to improve health services delivery

BackgroundThe aim of this study was to examine the acceptability of point of care computerized prompts to improve health services delivery among a sample of primary care patients.MethodsPrimary data collection. Cross-sectional survey. Patients were surveyed after their visit with a primary care provider. Data were obtained from patients of ten community-based primary care practices in the spring of 2001.ResultsAlmost all patients reported that they would support using a computer before each visit to prompt their doctor to: do health screening tests (92%), counsel about health behaviors (like diet and exercise) (92%) and change treatments for health conditions (86%). In multivariate testing, the only variable that was associated with acceptability of the point of care computerized prompts was patients confidence in their ability to answer questions about their health using a computer (beta = 0.39, p = .001). Concerns about data security were expressed by 36.3% of subjects, but were not related to acceptability of the prompts.ConclusionsSupport for using computers to generate point of care prompts to improve quality-oriented processes of care was high in our sample, but may be contingent on patients feeling familiar with their personal medical history.

Primer on medical professionalism.

Medicine as a profession depends on a unique social contract between the public and health-care professionals. We define professionalism in medicine, provide examples of challenges in professionalism relevant to podiatric medicine, and offer resources on ethics and professionalism in medicine. Medical professionalism is the set of attitudes, values, and conduct exhibited by medical providers resulting from placing patients and societys interests above their own. The primacy of patient welfare has been at the core of a set of values held by medical professionals since the drafting of the Hippocratic Oath, and it remains at the center of medical professionalism today.

Reversal of Associations Between Spanish Language Use and Mammography and Pap Smear Testing

Latina women are less likely to utilize cancer screening services than are non-Latina White women. The purpose of this study is to examine the relationship between preferred language (English vs. Spanish) and receipt of mammography and Pap-smear testing among US Latinas and non-Latinas. Cross-sectional analysis of the 2008 and 2010 Behavioral Risk Factor Surveillance System (BRFSS) surveys. While Latinas responding to the BRFSS in English or in Spanish had unadjusted lower odds of receiving mammography testing, in multivariable analysis Latinas responding-in-Spanish had 2.20 times the odds (ORxa0=xa02.20, 95xa0% CI, 1.90–2.55) of reporting mammography compared to non-Latinas. Similarly, Latinas responding-in- Spanish had lower unadjusted odds of receiving Pap-smear testing. However, Latinas responding-in-Spanish had 2.37 times the odds (ORxa0=xa02.37 CI, 2.04–2.75) of reporting having received Pap smear testing compared to non-Latinas in multivariate analysis. The results of this paper further confirm the “reversed associations” among Latinas and mammography and Pap smear testing described in previous studies and suggest that in addition to insurance status, preferred language may be a key variable contributing to the reversal phenomenon observed among Latinas.

APPLIED RESEARCH: Attitudes Toward the Physical Examination: A Comparison of U.S. and Dominican Medical Students

Background: Little information exists regarding whether medical students learning in relatively resource-scarce countries develop greater confidence in their physical examination skills or whether, compared to U.S. medical students, they have more positive attitudes regarding the utility of the physical examination. Purpose: To compare U.S. And Dominican medical students attitudes toward the physical examination. Methods: We surveyed final-year students at 1 medical school in the United States and 1 in the Dominican Republic regarding self-confidence in and perceived utility of the physical examination. Using 5-point Likert-type scales with response choices ranging from 1 (not at all confident) to 5 (very confident) and 1 (not at all useful) to 5 (very useful), respondents reported their attitudes toward the physical examination overall and toward 14 specific physical examination skills. Results: The survey response rate was 117/164 (71%). Students at the Dominican school, compared to students at the U.S. school, reported significantly greater confidence in their overall physical examination skill (mean response 4.27 vs. 3.79, respectively, p <. 001) and more positive views about the utility of the physical examination overall for providing diagnostically useful information (mean response 4.78 vs. 4.42, respectively, p <. 001). Results for the specific skills also showed more positive attitudes in the students from the Dominican medical school. Conclusions: Students at a Dominican medical school reported more positive attitudes toward the physical examination than students at a U.S. medical school.