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

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Medlineplus project: premium information for patients

From the December ACP Observer, copyright 2003 by the American College of Physicians.

By Edward Doyle

When patients need more information on a disease or a condition, hundreds of ACP members in Georgia and Iowa have discovered an easy way to "prescribe" credible health care information to their patients: They simply pick up a prescription pad and write in a diagnosis like "hypertension." The script directs patients to a URL that they can then type into their computer at home or the local library.

The prescription pad is just one part of a project being conducted by the National Library of Medicine (NLM) and the ACP Foundation. The goal of the Internet Health Information Referral Project is to encourage patients to visit the NLM's Web site, Medlineplus, to find evidence-based, easy-to-understand health care information.

The physicians in the pilot program are using an "information Rx pad" that helps direct patients to enter their diagnosis into the search function on the Medlineplus home page. Once physicians write in the appropriate diagnosis, they have helped connect patients with information on treating and managing their condition.

High marks

The program has proved to be popular with ACP members. According to a survey of internists who participated, more than half (52%) said they were now referring more patients to the Web for health-related information. While 59% of those doctors referred patients to the Web before the pilot program, 92% now send patients to Medlineplus. About one-third of ACP members in both states participated in the project.

Jacqueline W. Fincher, FACP, coordinator of the project in Georgia, said the big challenge was convincing physicians to actually visit the Web site to check out the information. "Once they got a sense of the project and visited the Web site themselves," she said, "their reaction was typically 'Wow.' "

The physicians were comfortable referring patients to the site because it offers the latest in journal articles and research on more than 600 common health conditions. To help get the word out to patients to use Medlineplus, the internists received a kit with several tools, including posters for their exam rooms and bookmarks to give patients.

However, the information Rx pad remains the project's most popular tool. Dr. Fincher, who is managing partner of McDuffie Medical Associates, a four-physician primary care group in Thomson, Ga., said that being able to whip out a pad to write in diagnoses makes the process easy—and authoritative.

"I liked the notion of using the prescription pad, because it emphasizes to patients that this information is as important as any medicine I can give you," she said. "It is part of the therapy to learn more about what you can do to treat the condition yourself."

Challenges: access and illiteracy

While the project has convinced internists to refer their patients to Medlineplus, challenges remain. Internists in both states identified illiteracy and low reading levels among their patients as a key problem.

Medlineplus offers one feature geared to patients with low reading skills. The interactive health tutorials feature provides 10-minute slide shows with sound on more than 160 diseases, tests and diagnostic procedures. Patients can listen to those tutorials simply by clicking on an "audio" button.

Project officials in both Georgia and Iowa also worked with community librarians so they would be able help patients who asked how to use Medlineplus. And despite concerns about illiteracy, physicians in Iowa reported good experience working with two groups of patients who are often assumed to have problems accessing computers: the indigent and the elderly.

Steven R. Craig, FACP, project coordinator for Iowa and Governor for ACP's Iowa Chapter, said that a handful of the residents at University of Iowa-Des Moines, where he is program director, have encouraged patients in their continuity clinics to use the Medlineplus Web site. Because one of the clinics serves an indigent population and the other serves a group of mostly older men at the local VA, some residents and physicians questioned whether patients would use the Web site.

They found that many patients were interested—and that they found ways to get information despite illiteracy or not having a computer.

"We have some preconceived notions that older and indigent patients don't have access to or the educational background to use the Internet," he said. "But even folks who don't have a computer will find a way to access the Internet to look up information about their health."

Instead of just giving patients the script referring them to Medlineplus, Dr. Craig's residents use a more direct approach. They print out pages of information from the Web site and give them to patients, telling them about the site in case they want more information.

The conference rooms where residents discuss each patient with an attending are equipped with a computer and printer. While discussing the case, residents find relevant Medlineplus material, print it out and take it back with them to the patient in the exam room.

Office staff

Most practicing physicians, however, don't have time to surf the Web on their patients' behalf. That's why many doctors in the pilot program relied on office staff to guide patients to the Medlineplus site. In focus groups conducted after the first phase of the project, a number of physicians who participated said they needed more help training office staff to get involved in working with patients.

"If the physician says, 'I'd like to refer you to the NLM Web site about your cholesterol,' it's probably going to be someone in the office who shows them how to do that," said Ruth-Marie E. Fincher, FACP, Governor for ACP's Georgia Chapter who has been involved with the project. "Tutorials for office staff would be very beneficial."

As the project moves forward, the NLM and ACP Foundation are considering these and other recommendations made by internists who took part in the project. The pilot program is currently being rolled out for members of the Virginia chapter, and the program will be offered to all College members at the 2004 Annual Session in New Orleans.

For more information on the project or to participate, call the ACP Foundation at 877-208-4189. You can also visit the Foundation online.

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