Medical Device Daily Contributing Writer

BARCELONA — An emerging practice for keeping patients in the loop and capable of making decisions about their health is the information prescription, presented at the World Healthcare Congress by Petra Wilson, director of public sector healthcare in the UK for Cisco Systems (San Jose, California). "People respond well to being guided," she said, "and here is an opportunity to build on the trust in the medical relationship."

A former deputy director of the European Health Management Association who created e-health road map for the European Commission, Wilson said capabilities for data management and communication created by e-health systems provide caregivers with new tools for dispensing information to individuals.

"Sending a patient to the Internet is like asking them to drink from a fire hydrant," she said. E-mails, direct television, interactive training and text messages to mobile phones are now readily available, along with the expected web references and printed brochures.

An info-prescription program should be based on the same principles as pharmacy prescriptions, using a formulary, an issuing service and an access service, Wilson said.

An evolution of the "bibliotherapy" program pioneered by the German National Library Association, the electronic tools for pushing information to a patient are coordinated with patient care, she added.

The UK Department of Health has called for information prescriptions to be issued routinely by 2008 at different stages in the care pathway as a routine part of the consultation that patients can expect.

The quality of the prescription information plan depends entirely on the quality of information the patient is given or directed to review, Wilson said.

"Is the information usable?" she asked, citing a study by Roy Kessels, PhD, of Utrecht University (Utrecht, the Netherlands), published in the Journal of the Royal Society of Medicine, that showed 40%-80% of medical information is forgotten immediately by a patient "and what is remembered is wrong."

According to Kessels, "patients tend to focus on diagnosis-related information and fail to register instructions on treatment."

Patient compliance to an info-prescription is also as problematic as for other therapies, she said, citing results from a pilot program conducted by the National Library of Medicine (Washington) that showed 65% of patients used a designated Internet link that was prescribed during a consultation, but that with an e-mail reminder, almost half of the remaining patients subsequently checked the link.

The NLM's Health Information Rx program issued customized prescription pads to doctors to point patients to health information in the library's MEDLINEplus online database.

While patients today seek out information on the Internet, patients should not be left unguided to wander the web, argued C lia Boyer, executive director of the Health On the Net Foundation (HON; Geneva, Switzerland).

"There is no overview for information on the Internet, none, and no regulation at all," she said. The ease of putting information online is exactly the problem. "The patient is not skeptical enough."

An evaluation by HON of 5,941 websites and 1,329 web pages found one-third contained inaccurate information. Closer analysis showed the inaccuracy levels highest for lifestyle conditions, with 89% of nutrition information and 45% of diet advice being wrong. Web-sourced information for prostate or breast cancer, on the other hand, was found 95% reliable.

Boyer said the HONcode is considered the de facto standard for accreditation of websites offering medical information. Over 5,000 websites have received the HONcode endorsement, and the foundation offers a browser plug-in as an online search tool for pathology-specific information available on accredited sites.