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EDITORIALS: Tom Ferguson From patients to end users BMJ 2002; 324: 555-556 [Full text]

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Simple Steps

Ned Hoke   (9 March 2002)

'He is a truly great man, who does not cling to power.' (M Blennerhassett, 2002)

Mitzi AJ Blennerhassett   (9 March 2002)

Internet Health Information : a London perspective

Trishan Panch   (25 April 2002)

Simple Steps 9 March 2002
Ned Hoke, Ecological Medicine Practice Calif/USA Send response to journal: Re: Simple Steps	Dr. Ferguson writes as one who knows of what he speaks. His proofs seem only to decorate his observation rather than provide it's structure or conclusion. Genuine healthcare process is, in truth, such an enormous social task requiring almost endless resources this author's study gives grateful hope toward useful end-user engagements. Simply the assertion that the ordinary citizen has substantial capacity to effectively and thoughtfully participate coupled with the breadth of opportunity via the net is itself still a true medical revolution. That said I continue to hope genuine Public Health will find additiional rebirth as an effective and pro-active supporter of true well being with the net being one of it's better voices.
'He is a truly great man, who does not cling to power.' (M Blennerhassett, 2002) 9 March 2002
Mitzi AJ Blennerhassett, secretary, Cancer Concern self help & support group & campaigner York , surrounding area (and the world) Send response to journal: Re: 'He is a truly great man, who does not cling to power.' (M Blennerhassett, 2002)	Yes! Hurrah! Congratulations! But will you ever convince those who know better? Thank you for this gem. You give this end user (and thousands like me) hope. Who knows, with a few cloned Tom Fergusons, my monthly newsletter marathon might become unnecessary, patient/doctor communication and patient choice might eventually become meaningful - and I might even be tempted to change my email address to something less provocative! Tom Ferguson has taken the trouble to discover the truth about end users and demonstrates his respect. He will have earned their respect 1000 fold.
Internet Health Information : a London perspective 25 April 2002
Trishan Panch, PRHO Central Middlesex Hospital, London Send response to journal: Re: Internet Health Information : a London perspective	I read the recent internet theme issue (9 March 2002) with great interest. As a fledgling clinician with a belief in the ideals of patient empowerment I am excited by the possibilities of the internet to deliver higher quality, more patient centred care, especially for those patients with chronic disease. Information potentially empowers patients to collaborate with their “wise and caring” <1> doctors in making decisions on their health. The importance of quality health information to NHS strategy is voiced in Our Healthier Nation <2> and more specifically in Information for Health <3> which states that “readily accessible, relevant, research based information in a format that is useful to patients” is central to the Expert Patients<4>program for the management of chronic disease. Official statistics suggest that the internet is an accessible and affordable source of information. 1/3 of the UK population is online (more than any other European country), 90% of UK employees work in businesses which are connected to the internet, and the UK is the cheapest place in the world for off peak internet access <5>. In practice strong reservations have been voiced as to how useful Internet Heath information is to patients. In a systematic survey of www advice on managing fever in children at home Impicciatore et al <6> found that “ It was difficult for parents to put the information they receive into practice as it is often incomplete and misleading..Only a few web pages reviewed gave complete and accurate information.” Eysenbach et al <7> concurred that “variability in quality limits the use of the Internet as a Health resource.” In an effort to address this variability researchers have evaluated web pages in different disciplines and attempted to define a list of requirements for users to evaluate their quality. A recent systematic evaluation of the quality of health information <8> reports that “despite these apparently unproductive attempts to amend the situation, it has improved.” During my work as a PRHO in General Practice I was interested in how much impact internet health information has had on an inner city practice population. A questionnaire was used to investigate a random sample of 100 of the practice population of 8064. The sample, though small was representative of the practice population with respect to age, sex, and ethnic origin. 54% had access to a computer in their own home, and 41 % had used the internet at some point. Those that did use the internet tended to be employed, Students, of the younger age groups, and were more likely to own a computer in their own home. Participants were asked the question: “It is important that I look for information on my health so that I may take a greater part in decision making with my doctor. ” 69% agreed, 14% of people disagreed, and 17% were undecided. Out of those that agreed, 1/3 did not in practice look for health information at all, and only 20% looked for Health Information on the internet. Out of this group (13) 11 disagreed that it had improved their understanding of their health and 2 were undecided whether it had improved their understanding or not. The findings of this exploratory study differ from those of the Pew Internet and American Life Projects <9> as quoted in Tom Ferguson’s lead article<1>. Whilst empowerment is a worthwhile strategic end, and promoting the availability of information through the internet is a theoretically effective means; in practice the patients in this study did not feel that internet health information had made much impact on their understanding of their health and their ability to make more informed decisions concerning their care. References 1. Ferguson T, From patients to end users; Quality of online patient networks needs more attention than quality of online health information BMJ 2002; 324:555-6 2. Department of Health, Our Healthier Nation. NHS 1998 3. Department of Health, Information for Health - An Information Strategy for the Modern NHS 1998–2005. A national strategy for local implementation. NHS Information Authority 1998 4. Department of Health, The Expert Patient : A New Approach to Chronic Disease Management for the 21st Century. NHS 2001 5. Department of Health, Building the information core: Implementing the NHS plan. NHS Information Authority 2001 6. Impicciatore et al, Reliability of health information for the public on the world wide web: systematic survey of advice on managing fever in children at home. BMJ 1997; 314:1875 7. Eysenbach G, Rating information on the Internet can empower users to make informed decisions. Letters BMJ 1999;319:385 8. Pandolfini C, Bonati B, Follow up of quality of public oriented health information on the world wide web: systematic re-evaluation. BMJ 2002;324:582-3 9. Fox S, Lee R. The online health revolution: how the web helps Americans take better care of themselves. The Pew Internet and American Life Project, Washington, DC, 26 November 2000. www.pewinternet.org/reports/toc.asp?Report=26