Maria Magdalena Bujnowska-Fedak

Online Communication Between Doctors and Patients in Europe: Status and Perspectives

Background Use of the Internet for health purposes is steadily increasing in Europe, while the eHealth market is still a niche. Online communication between doctor and patient is one aspect of eHealth with potentially great impact on the use of health systems, patient-doctor roles and relations and individuals’ health. Monitoring and understanding practices, trends, and expectations in this area is important, as it may bring invaluable knowledge to all stakeholders, in the Health 2.0 era. Objective Our two main goals were: (1) to investigate use of the Internet and changes in expectations about future use for particular aspects of communication with a known doctor (obtaining a prescription, scheduling an appointment, or asking a particular health question), and (2) to investigate how important the provision of email and Web services to communicate with the physician is when choosing a new doctor for a first time face-to-face appointment. The data come from the second survey of the eHealth Trends study, which addressed trends and perspectives of health-related Internet use in Europe. This study builds on previous work that established levels of generic use of the Internet for self-help activities, ordering medicine or other health products, interacting with a Web doctor/unknown health professional, and communicating with a family doctor or other known health professional. Methods A representative sample of citizens from seven European countries was surveyed (n = 7022) in April and May of 2007 through computer-assisted telephone interviews (CATI). Respondents were questioned about their use of the Internet to obtain a prescription, schedule an appointment, or ask a health professional about a particular health question. They were also asked what their expectations were regarding future use of the Internet for health-related matters. In a more pragmatic approach to the subject, they were asked about the perceived importance when choosing a new doctor of the possibility of using email and the Web to communicate with that physician. Logistic regression analysis was used to draw the profiles of users of related eHealth services in Europe among the population in general and in the subgroup of those who use the Internet for health-related matters. Changes from 2005 to 2007 were computed using data from the first eHealth Trends survey (October and November 2005, n = 7934). Results In 2007, an estimated 1.8% (95% confidence interval [CI], 1.5 - 2.1) of the population in these countries had used the Internet to request or renew a prescription; 3.2% (95% CI 2.8 - 3.6) had used the Internet to schedule an appointment; and 2.5% (95% CI 2.2 - 2.9) had used the Internet to ask a particular health question. This represents estimated increases of 0.9% (95% CI 0.5 - 1.3), 1.7% (95% CI 1.2 - 2.2), and 1.4% (95% CI 0.9 - 1.8). An estimated 18.0% (95% CI 17.1 - 18.9) of the populations of these countries expected that in the near future they would have consultations with health professionals online, and 25.4% (95% CI 24.4 - 26.3) expected that in the near future they would be able to schedule an appointment online. Among those using the Internet for health-related purposes, on average more than 4 in 10 people considered the provision of these eHealth services to be important when choosing a new doctor. Conclusions Use of the Internet to communicate with a known health professional is still rare in Europe. Legal context, health policy issues, and technical conditions prevailing in different countries might be playing a major role in the situation. Interest in associated eHealth services is high among citizens and likely to increase.

The impact of telehome care on health status and quality of life among patients with diabetes in a primary care setting in Poland.

BACKGROUND Telehome care has been proposed as a solution to the challenges of providing effective and affordable care for patients with diabetes. METHODS A total of 100 adult patients with type 2 diabetes-divided between insulin and noninsulin requiring-was enrolled in a randomized, controlled trial aimed at investigating the effects of telehome monitoring. The experimental group (n = 50) received an in-home wireless glucose monitor and transmitter, whereas the control group (n = 50) was instructed to follow the conventional arrangement. RESULTS There was an overall reduction in HbA1c values in both experimental and control groups after 6 months. A significant difference in HbA1c values between the groups was observed only among the noninsulin-requiring patients (decline from 6.95% ± 0.82% to 6.66% ± 0.86% in IB vs. 7.21% ± 2.02% to 7.2% ± 1.86% in IIB; p = 0.02). The experimental group reported considerably less hyperglycemic and hypoglycemic events. The profile of the patient who benefited the most from telemonitoring consisted of older, more educated patient who had acquired the disease relatively recently, and who spends most of the time at home. The experimental group had higher overall scores on quality of life measures and sense of control over diabetes. There was a positive association between educational attainment and ability to use the telemonitoring system without help (p = 0.045). CONCLUSIONS Although not conclusive because of the small sample and short observation period, the study suggests that telehome monitoring is an effective tool in controlling type 2 diabetes in a primary care setting.

Telemedicine for diabetes support in family doctors' practices : a pilot project

A telemedicine support system for diabetes management was compared with standard monitoring of patients with diabetes. The telemedicine system was composed of two modules: a Patient Unit and a Medical Unit connected by the telecommunication network. The study involved 60 patients of family doctors’ practices in the Lower Silesia Region who were diagnosed with diabetes. There was no significant difference in haemoglobin A1c between telemonitoring and the traditional group of diabetic patients during the survey. The patients’ quality of life slightly improved in the telemonitoring (mean score 3.4) and the traditionally monitored group (mean score 3.2), but there was no significant difference between them. Most of the telemonitoring patients (75%) expressed the desire to continue with telemedicine support and nearly 60% of patients monitored with traditional methods wanted to be included in the telemedicine group. The system seems to be reliable, simple to use and friendly for the patients.

Trends in the use of the Internet for health purposes in Poland

BackgroundIn Poland, like in other European countries and in accordance with the global trend, the number of computer users and people who have access to the Internet has increased considerably. The study investigates trends and patterns of Polish health-related Internet use over a period of seven years. The main objective of the study was to estimate the change in the proportion of the population using Internet for health purposes and to show the potential trend in perceptions and preferences of Polish citizens in this respect as well as factors affecting their use.MethodsThe study was based on three national surveys that were conducted in 2005, 2007, and 2012. A total of 3027 adult citizens were selected randomly from the Polish population. A sample collection was carried out by Polish opinion poll agencies by computer-assisted telephone interviews. The subjects were asked to respond to general questions about their Internet use and their Internet use for health-related purposes, as well as to express their opinions about various sources of medical information, frequency, and the need for direct communication with health professionals via the Internet and other interactive forms of online activities.ResultsThe proportion of the Polish population that used the Internet for health-related purposes increased significantly (41.7% in 2005, 53.3% in 2007, and 66.7% in 2012). The Internet has become an important source of health information for almost half of Polish citizens, overtaking television, radio, press, and courses or lectures in the ranking list. As the medium matures, the use of interactive, health-related online services has also increased remarkably. However, while the main users of the Internet are certainly younger people, the largest growth potential has been observed among the elderly. The profile of the most likely Internet user and the citizen for whom the Internet is an important source of health information has been determined.ConclusionsThe Internet offers enormous opportunities, particularly for providing and improving consumer information services with regard to health care. A sharply increasing trend regarding Internet use, Internet use for health purposes, and the interactive use of the Internet related to health has been observed among Polish citizens.

A survey of Internet use for health purposes in Poland

We investigated the use of the Internet for health-related purposes in Poland. A telephone survey was performed of 1027 people between 15 and 80 years old who were selected from the Polish population by random sampling. The study showed that the Internet was used by 47% of the respondents (n = 483) and 37% of the respondents (n = 376) had used it at least once a week. Almost 80% of responders used the Internet to obtain information about health or illness (n = 383) and 43% of them did it at least once a month. The respondents used the Internet for health purposes mainly to read about health or illness (95%). Only 3% of them approached the family physician, specialist or other health professional over the Internet. However, when choosing a new doctor, 45% of respondents stated that the doctors provision of Internet-based services was of importance. At present the Internet is not used as a health communications channel but it is clear that many Polish people are interested in Internet-based health services.

FOCUS : Frailty management optimisation through EIPAHA commitments and utilisation of stakeholders’ input – an innovative European project in elderly care*

The goal of FOCUS, which stands for Frailty Management Optimization through EIPAHA Commitments and Utilization of Stakeholders’ Input, is to reduce the burden of frailty in Europe. The partners are working on advancing knowledge of frailty detection, assessment, and management, including biological, clinical, cognitive and psychosocial markers, in order to change the paradigm of frailty care from acute intervention to prevention. FOCUS partners are working on ways to integrate the best available evidence from frailty-related screening tools, epidemiological and interventional studies into the care of frail people and their quality of life. Frail citizens in Italy, Poland and the UK and their caregivers are being called to express their views and their experiences with treatments and interventions aimed at improving quality of life. The FOCUS Consortium is developing pathways to leverage the knowledge available and to put it in the service of frail citizens. In order to reach out to the broadest audience possible, the FOCUS Platform for Knowledge Exchange and the platform for Scaling Up are being developed with the collaboration of stakeholders. The FOCUS project is a development of the work being done by the European Innovation Partnership on Active and Healthy Ageing (EIPAHA), which aims to increase the average healthy lifespan in Europe by 2020 while fostering sustainability of health/social care systems and innovation in Europe. The knowledge and tools developed by the FOCUS project, with input from stakeholders, will be deployed to all EIPAHA participants dealing with frail older citizens to support activities and optimize performance.

Usage of Medical Internet and E-Health Services by the Elderly

Internet and e-health services have a substantial potential to support efficient and effective care for the elderly. The aim of the study was to investigate the use of Internet for health-related purposes among Polish elderly, the frequency and reasons of use, the importance of e-health services, and factors affecting their use. A total of 242 elderly at the age of ≥60 years were selected from the Polish population by random sampling. Data collection was carried out by phone interviews in October-November 2012. The study shows that the Internet was ever used by 32% of the elderly and 1/5 claimed a regular use. Among the Internet users, 81% of older people used it to obtain information about health or illness. The Internet was one of the less important sources of information (important for 27% of respondents), face to face contact with health professionals and family and friends are still the most required source of medical information (75%). Only 7% of elderly Internet users approached the family physician, specialists, or other health professionals over the Internet. Factors that positively affected the use of Internet among elderly were male gender, younger age, higher education, living with family, mobile phone use, and a subjective assessment of ones own health as good. The doctors provision of Internet-based services was important in the opinion of approximately 1/4 of older people. We conclude that the development of information and communications technology (ICT) tools increasingly meets the evolving needs of patients in the field of e-health. More and more elderly become beneficiaries of these services.

Understanding frailty: a qualitative study of European healthcare policy-makers' approaches to frailty screening and management

Objective To elicit European healthcare policy-makers’ views, understanding and attitudes about the implementation of frailty screening and management strategies and responses to stakeholders’ views. Design Thematic analysis of semistructured qualitative interviews. Setting European healthcare policy departments. Participants Seven European healthcare policy-makers representing the European Union (n=2), UK (n=2), Italy (n=1), Spain (n=1) and Poland (n=1). Participants were sourced through professional networks and the European Commission Authentication Service website and were required to be in an active healthcare policy or decision-making role. Results Seven themes were identified. Our findings reveal a ‘knowledge gap’, around frailty and awareness of the malleability of frailty, which has resulted in restricted ownership of frailty by specialists. Policy-makers emphasised the need to recognise frailty as a clinical syndrome but stressed that it should be managed via an integrated and interdisciplinary response to chronicity and ageing. That is, through social co-production. This would require a culture shift in care with redeployment of existing resources to deliver frailty management and intervention services. Policy-makers proposed barriers to a culture shift, indicating a need to be innovative with solutions to empower older adults to optimise their health and well-being, while still fully engaging in the social environment. The cultural acceptance of an integrated care system theme described the complexities of institutional change management, as well as cultural issues relating to working democratically, while in signposting adult care, the need for a personal navigator to help older adults to access appropriate services was proposed. Policy-makers also believed that screening for frailty could be an effective tool for frailty management. Conclusions There is potential for frailty to be managed in a more integrated and person-centred manner, overcoming the challenges associated with niche ownership within the healthcare system. There is also a need to raise its profile and develop a common understanding of its malleability among stakeholders, as well as consistency in how and when it is measured.

Factors Influencing Utilization of Primary Health Care Services in Patients with Chronic Respiratory Diseases

The purpose of our study was to determine the factors affecting the level of services provided in primary health care among patients with chronic respiratory diseases. The study group consisted of 299 adults (median age: 65, min-max: 18-92 years) with mixed chronic respiratory diseases, recruited from patients of 135 general practitioners. In the analysis, in addition to the assessment of the provided medical services, the following were used: Patient Satisfaction Questionnaire, Camberwell Assessment of Needs Short Appraisal Schedule, Acceptance of Illness Scale, and WHO Quality of Life Instrument Short Form. Variables that determined the level of services were the following: age, place of residence, marital status, number of chronic diseases, and level of disease acceptance, quality of life, and health behaviors. The level of provided services correlated with variables such as gender, severity of somatic symptoms, level of satisfied needs, and satisfaction with health care. We concluded that in patients with mixed chronic respiratory diseases a higher level of health care utilization should be expected in younger patients, those living in the countryside, those having a partner, with multimorbidity, a low level of disease acceptance, those satisfied with their current quality of life, with positive mental attitudes, and maintaining health practices.

Frailty syndrome in community care: tips for patients and caregivers

frailty syndrome is a dynamic condition characterized by a decrease in the physiological body reserves, weakened resistance to stressors and impaired functioning of the body systems. frailty syndrome is expressed through weight loss, reduced muscle strength, problems with walking, maintaining balance and a decrease in physical activity. there are three stages of frailty syndrome: pre-frail, frail and complications of frailty syndrome. the main risk factor of the disease is old age, but genetic and environmental influences are also important, as well as lifestyle and co-morbidities. diagnosis of frailty syndrome is made, among others, based on the fried scale, the rockwood scale and gfI (groningen frailty Index). the basis of prevention of frailty syndrome is regular physical activity and a combination of aerobic, strengthening and stretching exercises. the role of a diet containing foods rich in protein, vitamins, especially vitamin d, leucine and omega-3 is also emphasized. besides these, vitamin D supplementation, treatment of co-morbidities and vaccinations to prevent infectious diseases should be taken into consideration. A huge role in the prevention of complications of the disease is played by the family and caregivers of the elderly, who should pay attention to the first symptoms of the disease and take steps to minimize the risk of frailty syndrome and to slow the disease.