Patient Internet Usage Characteristics of a Foot and Ankle Population

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1 Patient Internet Usage Characteristics of a Foot and Ankle Population David A. Palms, BA Jeremy T. Smith, MD Christopher P. Chiodo, MD Eric M. Bluman, MD, PhD

2 Our disclosures are in the Final AOFAS Program Book. None of the authors have potential conflicts with this presentation.

3 Background Internet use is common and increasing [1] million users in US (44% of pop.) million users in US (77% of pop.) Health-related Internet use has greater growth than general Internet use [2] million users in US million users in US million users in US Patients who access health-related information online more likely to: Want to be more active participants in future medical decision making [3] Follow physician advice more closely [4] Ask more questions during office visits [4]

4 Background Health-related Internet use is greater in certain populations Younger [5,6,7,8] Employed [5] More formal education [6,9] Higher annual income [8] Worse health [9] Living in urban location [9]

5 Introduction Primary goals of this study Characterize general and health-related Internet use for patients seeking orthopedic foot and ankle care Determine whether age, educational level, or language fluency correlated with Internet usage characteristics

6 Methods Study Time Frame: September 2010 to February 2012 Subjects: All new patients of PI s ortho. F&A surgery practice Instrument: Patient Internet Usage survey. Surveyed information: Internet use Frequency of Internet use Ability to access Internet alone Needing help when using the Internet Location using the Internet Internet access at home Awareness of medical information on the Internet Using Internet for health-related information before visit Alternate sources of health-related information

7 Results Patient population characteristics 1179 subjects (response rate = 95%) 66% female Mean age = 50 yr. 15 % <30 yr. old, 17% >65 yr. old 94% spoke English fluently 11% spoke Spanish fluently <1% reported speaking a language other than English or Spanish 79% were college-educated 31% have graduate degree 5% do not have high school degree or GED

8 Results 88% of the study population used the Internet 92% of population were aware that there is health-related information on the Internet about orthopedic foot and ankle conditions 45% looked up health-related information related to their visit before arriving

9 Results - General 95% of those using the Internet were able to access and use it alone Of those who used alternate sources to gather information about their condition: 65% used another physician 54% used the Internet 30% used family or friends 23% used an allied/complementary health provider 19% used a nurse 14% used books/pamphlets

10 Results - Age Inverse correlation between age and Internet use Approx. 20% less of patients >65 yr old use Internet daily than those <30 yr old

11 Results - Age Age negatively correlated to awareness of healthrelated information Six times more patients <30 yr old use cell phone to access internet than patients >65 yr old

12 Results Education Patients with at least some college education significantly more likely to use Internet than those with no college education (* p < 0.01) *

13 Results Spanish Speakers Patients fluent in Spanish: Less likely to use the Internet Less likely to be aware of information on the Internet about their medical condition Less likely to look up medical information before their visit Less likely to be able to use Internet alone

14 Results Language Fluency Patients fluent in Spanish equally likely to use all sources of medical information EXCEPT the Internet (** p < 0.05, * p < 0.1)

15 Conclusions High rates of Internet use, frequency, home access, and online health information awareness in our population Usage lags in older, less-well-educated, and Spanish speaking patients Online resources should be rethought with older, less formally educated, and Spanish speaking patients in mind. Spanish translation of FootCareMD.org should help to in counteracting lower internet usage rates in spanish-only speaking population

16 Study Limitations Study subjects from a single orthopaedic F&A practice Catchment area as well as referral patterns led to predominance of patients from eastern Massachusetts area Socioeconomic characteristics of Metro. Boston may have resulted in greater English-speaking patient population with more formal education Potential bias: Use of interpreter for patients who did not speak English fluently causing social pressure to give what they consider proper responses

17 References 1. Internet World Stats. Accessed 2010 Sep Harris Interactive. The Harris Poll #95, 'Cyberchondriacs' on the Rise? Available at: tl/readcustom%20default/default.aspx. Accessed February 21, Lee CJ, Gray SW, Lewis N. Internet use leads cancer patients to be active health care consumers. Patient Educ Couns. 2010;81:S Iverson SA, Howard KB, Penney BK. Impact of Internet use on health-related behaviors and the patient-physician relationship: a survey-based study and review. J Am Osteopath Assoc. 2008;108: Dumitru RC, Burkle T, Potapov S, Lausen B, Wiese B, Prokosch HU. Use and perception of internet for health related purposes in Germany: results of a national survey. Int J Public Health. 2007;52: Grant RW, Cagliero E, Chueh HC, Meigs JB. Internet use among primary care patients with type 2 diabetes: the generation and education gap. J Gen Intern Med. 2005;20: Gupte CM, Hassan AN, McDermott ID, Thomas RD. The Internet friend or foe? A questionnaire study of orthopaedic out-patients. Ann R Coll Surg Engl. 2002;84: Mayben JK, Giordano TP. Internet use among low-income persons recently diagnosed with HIV infection. AIDS Care. 2007;19: McInnes DK, Gifford AL, Kazis LE, Wagner TH. Disparities in health-related Internet use by US veterans: results from a national survey. Inform Prim Care. 2010;18:59-68.

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