Doctor gets to heart of Internet’s impact on patient care

TORONTO — A Toronto doctor has just completed a four-year study that claims that Internet communication has a positive effect on heart failure patients.

When Dr. Robert Wu, a staff physician at Toronto General Hospital, started his

study back in 1999, he wasn’t sure there were enough patients actually online to conduct his study. His concerns were largely about elderly patients having access, but Internet adoption has skyrocketed since then. He determined that there were sufficient households with access to make a program like this work. He shared the results of his work at the E-Health 2003 conference Monday.

Wu set up a portal built on Microsoft Access database tools and hosted by the University of Toronto. Twenty-eight patients aged 32 to 83 were provided access to the portal that was staffed by three nurses and three cardiologists. The patients were encouraged to provide regular updates on their weight — since that would affect medical dosing — and their condition. Staffers responded with advice, dosage recommendations and answers to any medical queries.

Heart failure is typically the end-stage of conditions like heart disease. There are currently about 350,000 Canadians diagnosed with heart failure, which costs the Canadian health-care system more than $1 billion a year in patient care. The site was set up to handle day-to-day patient care, not to replace more pressing medical needs. “”We stressed very strongly that this was a method of non-urgent communication,”” said Wu. “”The question we had was, would even more communication improve the care?””

Wu’s project set out to answer other questions like, “”Is it safe? Do patients want it? Does it improve quality of life?”” He wanted to ensure that it could handle simple inquiries that would otherwise have necessitated a phone call or a visit. He also wanted to make sure that patients weren’t relying too heavily on the portal.

The role of the Internet in patient care isn’t yet clear, said Dr. Beth Abramson, director of the cardiac prevention centre at St. Michael’s Hospital in Toronto. “”I think we have to be cautious about giving individual advice to individual patients. In general, one has to have direct interaction with a patient to make significant changes in terms of prescribing medication,”” she said.

In one case, a patient of Abramson’s e-mailed in a serious heart problem rather than dialing 911. “”Fortunately, things turned out all right, but we have to be very careful about how people interpret and use the Internet and e-mail for discussing medical issues,”” she said.

Abramson encouraged patients to be proactive in their own health care by reading sites like the Heart and Stroke Foundation. Wu said his study was in part designed to help patients take a greater role in their own health issues. He noted that over time the nurses and doctors staffing the portal had to provide less in the way of medical knowledge and reassurances to patients.

One of the most popular aspects of the site was the comments field, he said. Patients used it about two-thirds of the time they logged on. “”I think this is what they found most useful about the site,”” he said.

The portal experienced some downtime issues (it went down three times for a period of 24 hours or longer), but patients generally had a positive experience, said Wu. “”Patients were satisfied with the site and appreciated frequent contact (with staff).””

Wu said he is still measuring the quality of life impact it had on patients to see it might be applicable to other areas of heath-care management.

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