A systematic review of patient acceptance of consumer health information technology.

A descriptive study of the use of the Internet by women seeking pregnancy-related information.

Study objective : To determine the correlates of compliance with follow-up appointments and prescription filling after an emergency department visit. Methods : This prospective cohort study was undertaken as part of the Emergency Department Quality Study evaluation of five urban teaching hospital EDs in the northeastern United States. Of 2,757 eligible patients who presented with abdominal pain, asthma, chest pain, hand lacerations, head trauma, or first-trimester vaginal bleeding and were enrolled during 1-month period, 2,315 (84%) completed on-site baseline questionnaires. Information about diagnoses, socioeconomic status, discharge instructions, insurance status, and primary care was obtained from the on-site patient surveys and from reviews of medical records. A 76% random sample of patients who completed the questionnaire was generated, and 1,386 patients (79% of the sample) were interviewed by telephone approximately 10 days after their ED visit to determine compliance with follow-up appointments and prescription filling. Results : Of the 1,386 patients interviewed at 10 days, 914 (66%) had been discharged from the ED, and 408 (45%) of those discharged recalled being advised to take a medication. Fifty of these patients (12%) reported that they did not obtain the medication. Significant independent correlates of not filling prescriptions were lack of insurance (odds ratio [OR], 2.4 ; 95% confidence interval [Cl], 1.1 to 5.5) and dissatisfaction with discharge instructions (OR, 2.8 ; 95% CI, 1.2 to 6.4). Two hundred thirty-five (26%) of the discharged patients said they were given follow-up appointments and did not have an appointment pending at the time of the interview ; 77 (33%) of these patients reported having missed their appointment. The only significant independent correlate of missing follow-up appointments was being given a telephone number to call instead of leaving the ED with an appointment scheduled (OR, 3.8 ; 95% CI, 1.7 to 8.8). Conclusion : No

Patient noncompliance with medical advice after the emergency department visit

Background: Access to health care is often contingent upon an individual’s ability to travel for services. Certain groups, such as those with physical limitations and rural residents, have more travel barriers than other groups, reducing their access to services. The use of the Internet may be a way for these groups to seek care or information to support their health care needs. Objective: The purpose of this study was to examine Internet use among those whose are, for medical reasons, limited in their ability to travel. We also examined disparities in Internet use by race/ethnicity and rural residence, particularly among persons with medical conditions. Methods: We used data from the 2001 National Household Travel Survey (NHTS), a nationally representative sample of US households, to examine Internet use among individuals with medical conditions, rural residents, and minority populations. Internet use was defined as any use within the past 6 months; among users, frequency of use and location of use were explored. Control variables included sociodemographics, family life cycle, employment status, region, and job density in the community. All analyses were weighted to reflect the complex NHTS sampling frame. Results: Individuals with medical conditions were far less likely to report Internet use than those without medical conditions (32.6% vs 70.3%, P < .001). Similarly, rural residents were less likely to report Internet access and use than urban residents (59.7% vs 69.4%, P < .001). Nationally, 72.8% of white respondents, versus 65.7% of persons of “other” race, 51.5% of African Americans, and 38.0% of Hispanics reported accessing the Internet (P < .001). In adjusted analyses, persons with medical conditions and minority populations were less likely to report Internet use. Rural-urban differences were no longer significant with demographic and ecological characteristics held constant. Conclusions: This analysis confirmed previous findings of a digital divide between urban and rural residents. Internet use and frequency was also lower among those reporting a medical condition than among those without a condition. After we controlled for many factors, however, African Americans and Hispanics were still less likely to use the Internet, and to use it less often, than whites. Policy makers should look for ways to improve the access to, and use of, the Internet among these populations. [J Med Internet Res 2011;13(1):e25]

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Subdividing the Digital Divide: Differences in Internet Access and Use among Rural Residents with Medical Limitations

Lingering questions and doubts: online information-seeking of support forum members following their medical visits.

This study was performed to assess inner city Emergency Department (ED) patients' use of the Internet to obtain medical information, and patients' interest in being provided medical links by their ED physician to learn more about their medical condition. A convenience sample of inner city ED patients were surveyed regarding computer/Internet access, past searches for medical information, and whether they desired medical links provided with discharge paperwork. Of 328 patients completing the survey, 178 (54%) had computers, whereas 150 (46%) had access to the Internet. Seventy-nine (24%) had previously used the World Wide Web (WWW) to obtain medical information, and 26 (33%) of these reported difficulty in obtaining useful information. One hundred ninety-two (59%) were interested or very interested in being provided links to medical sites. Patients more likely to want medical links were younger, college educated, and in higher salary ranges. There was no difference in desire to be provided links based on number of past medical problems or duration of symptoms. In conclusion, almost half the inner city ED patients in this survey have Internet access and over half were interested in being provided quality medical links as a part of their discharge paperwork.

Carlos Perez

Papers

Patient education and the Internet: do patients want us to provide them with medical web sites to learn more about their medical problems?