American College of Physicians: Internal Medicine — Doctors for Adults ®

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Make your waiting room a high-tech learning center

You can use electronic tools instead of old magazines to help patients make the most of their time waiting

By Bryan Walpert

Waiting to see the doctor is about to become a lot less boring for patients at the Denver practice of Brian Levy, ACP­ASIM Member. Instead of flipping through back issues of People magazine, they'll soon be able to learn about the side effects of their current arthritis medicine or study up on a new antidepressant. They'll access this information not by leafing through dog-eared brochures, but by clicking on a mouse.

Dr. Levy plans to set up a computer in his general internal medicine practice's waiting room with electronic drug "leaflets" available on CD-ROM. By searching through an interactive menu, his patients will be able to learn more about the drugs they're using. They'll read about indications, interactions, side effects, what to do if they miss a dose and how to get more information.

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Because he also works as medical director of a company that provides this type of information to Web sites, Dr. Levy is uniquely qualified to set up this innovative patient education format in his own practice. But all physicians can do the same with the help of several companies that offer high-tech—but affordable—ways for physicians to turn their waiting rooms into learning centers.

While your ultimate goal should be to eliminate patient waiting times, that's probably a long-term goal. Until that happens, here are some products you can use to help patients make the most of time spent in your waiting room.

'Free' TV

Television is one of the easiest and least expensive ways to educate as well as entertain patients in your waiting room. About 10,000 waiting rooms around the country are tuned into AccentHealth Network (800-791-8756), which offers CD-ROM programs on topics ranging from nutrition to child rearing. Past AccentHealth programs, which are produced by CNN, have examined such topics as the interaction of aspirin and a popular blood pressure drug, and research looking for genetic links to prostate cancer.

While physicians receive programming and hardware free, the service does broadcast commercials. Products typically include health-related items such as Bounty paper towels (the health link is that paper towels don't spread germs the way sponges might), over-the-counter drugs such as Benadryl and prescription drugs such as Lipitor and Claritin.

AccentHealth has placed equipment in offices with as few as two physicians, but it focuses on groups with four or five physicians. It does not offer the product to solo practitioners because too few patients will see the programming—and the commercials.

Nielson surveys commissioned by AccentHealth show that 96% of patients say that the programs make waiting time go more quickly, while 99% indicate they provide useful health information. Comments from physicians' offices, however, are more ambivalent.

"It's been a mixed response," said Helayne Williams, chief administrative officer at Sports Orthopedic and Rehabilitation Medicine Associates, a 19-physician practice in Menlo Park, Calif. that uses the service. "Some patients say, 'Turn that thing off, I can't stand it. It bothers me.' Others say, 'Turn the sound up, I can't hear it.' "

Yul D. Ejnes, FACP, also has mixed feelings about the program, which airs in his Cranston, R.I., internal medicine practice. "I have some problems with the advertisements. I have problems with direct-to-consumer advertising with drugs," said Dr. Ejnes, who is Transitional Governor for the College's Rhode Island Chapter. "We have had people ask us about products described in the ads. But at the same time, people have asked about health topics presented, so I think we've made an impact on those folks."

Changing behaviors

Does educating patients via television work? Researchers say yes, under certain conditions.

Michael P. Pignone, ACP­ASIM Member, found that a video program he created on colon cancer helped boost screening rates for the disease. In 1998, Dr. Pignone, an internist and assistant professor of medicine at the University of North Carolina-Chapel Hill School of Medicine, asked 125 men and women between the ages of 50 and 75 to watch an 11-minute video about colon cancer. The video discussed screening and testing options and suggested that patients discuss screening tests with their physician.

By color-coding brochures that were offered to patients, Dr. Pignone was able to measure their interest in screening. He found that about 38% of patients who watched the video underwent screening for colon cancer in the following three months, compared to 21% of patients in a control group.

One key to the experiment's success, Dr. Pignone said, is that patients watched the video in a separate room. He explained that for serious issues like colon cancer screening, a private video monitor, either in a separate room or viewing carrel, is more effective than having a group of patients watch a single monitor in a waiting room.

Dr. Pignone has since expanded his efforts to other physicians' offices and plans to create videos on other topics. "Theoretically, if you spend a little time and develop a few of these decision-making tools, at appropriate times you can plug them in," he said. "A breast cancer video one year, the next year learn about heart-disease factors." (A version of the colon cancer video is available on the Web at www.med.unc.edu/medicine/edursrc/colon.htm.)

Getting interactive

Some physicians, like Dr. Levy in Denver, are going even more high-tech and using personal computers to offer patients interactive education.

Also on the horizon is a computer-based product for physicians' offices from Helios Health Inc. (877-943-5467) in Atlanta. For the past several years, the company has been testing a computer-based women's health information system at 50 ob/gyn offices in Atlanta; Tampa, Fla.; Birmingham, Ala.; Nashville, Tenn.; and Philadelphia. The company has focused on women's health, with about 10 subject areas, including birth control and menopause. It is currently creating modules on new topics such as allergies, asthma, diabetes and heart disease.

Programs feature audio (users wear headphones), video and animation. A patient using a program on birth control, for example, can click on a particular contraceptive--such as the pill--and view a chart comparing it to other methods. With a few more clicks, the patient can learn about initial side effects, watch a video of women discussing their experiences and view an animated graphic showing how estrogen stops the release of the egg from the ovaries.

Helios plans to roll out the system to at least 1,000 more sites in metropolitan areas around the country by early next year. Each system includes a personal computer, a color monitor and a color printer. The educational programs are stored on the computer's hard drive, and Helios downloads new programs and updates at night via phone lines. The equipment is free to qualified practices (typically groups of at least four), though physicians must provide and pay for the phone line.

Results

To see how well patients work with such interactive learning tools, internist Thomas D. MacKenzie, ACP­ASIM Member, placed computers in two Denver clinics as part of a 1996 study of teenage risk behaviors. Patients accessed a 15-minute CD-ROM program at both the Westside Family Health Center and at a sexually transmitted disease (STD) clinic. The program collected information about age, race and gender, and it asked teens about their use of condoms and illegal drugs, about cigarette smoking and whether they carried a gun.

Although teens at the STD clinic reported that they often engaged in risky behavior, Dr. MacKenzie found that they seemed as willing to consider ways to quit smoking as teens in other settings. He believes the results indicate that STD clinics should counsel their teen patients to use seatbelts and stop smoking, as well as address issues like guns, drug use and safe sex practices.

Dr. MacKenzie noted, however, that interactive computer programs pose some unique problems. Because about 30% of his patients speak only Spanish, he would need Spanish versions of programs for a permanent interactive computer system in his clinic—and those are hard to find. And to reach the optimum number of patients, he'd need a program designed for a sixth-grade reading level. "It's hard to find good survey instruments at that reading level," Dr. MacKenzie said. "They're out there, but hard to find."

Brian Walpert is a freelance writer in Denver.

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