Internet based counseling to remote orthopedic patients.

Abstract

Copyright © Taylor & Francis 2004. ISSN 0001–6470. Printed in Sweden – all rights reserved. Sir—Internet-based counseling is a form of telemedicine that uses internet technology to inform or educate patients. We did a prospective study over 8 years to assess the efficiency of this type of counseling to underserved orthopaedic patients (Labiris et al. 2002). The patients could request information and professional advice on orthopedic matters via electronic mail. Their questions were answered by 31 physicians, including 18 consultant orthopaedic surgeons and general practitioners. The patients ̓ age, sex, residence, social situation, and medical/ orthopedic history were noted. The replies were given in everyday language. A quality-gap detection audit system monitored the service (Zeithaml et al. 1990). A seven-member expert committee supervised the scientific and ethical standards (Dyer 2001). Moreover, all cultural and religious differences in the various groups of patients were considered before answering the questions. The advisory role of the service was clarified and the importance of a physical examination and appropriate personal patient-doctor contact was emphasized. Between 1993 and 2001, 1,234 patients asked for advice: 747 were men (43 (18–77) years) and 487 women (55 (32–75) years). Most came from urban areas in USA, EU, Canada, and Australia (Table 1). Inaccessible patients requested counseling for various reasons: 611 wanted to evaluate Internet-based health services; 277 were not satisfied with their physician; 44 explicitly stated that the local medical services were inaccessible/ too expensive. Counseling was given to 1,021 patients (83%) (Table 2). The need for a physical examination and insufficient provision of medical data were the main reasons for failure to answer all requests. Apart from having their medical queries answered, a significant number of the inaccessible subjects participated in interactive educational sessions on common chronic diseases of the musculoskeletal system. During these sessions, groups of patients (i.e., with osteoporosis, rheumatoid arthritis) answered the available questionnaires and actively participated in internet-related “chats” in which the principal details of the relevant diseases were discussed—e.g., in the “osteoporosis” group, the importance of compliance to the physicians instructions and the need for dietary restrictions were strongly emphasized (Bourgon and Maillard 1998, Liel et al. 2001). The quality audit of the service was determined by attaching the electronic mails to predetermined questionnaires, in Likert-scale forms, concerning the quality dimensions of responsiveness, empathy, and reliability. In descending numerical order, these patients complained of the predictable delays of the service, language barriers (the service was available in English and German only), and the local availability of the Internet. However, almost all patients (> 90%) favored this type of counseling and stated that they planned to use it in the future. It should be mentioned that due to technical problems the portal became inaccessible five times; this meant a total of 44 days on which counseling was not possible. The internet physicians were interviewed by an independent psychologist and a group of IT experts. The general view was that Internet-based counseling can be used as a regular medical service. However, with present technology, it cannot replace conventional consultations with a physician (Kuppersmith 1999). Table 1. Demographic data of the patients (n = 1556)