인터넷과의료이용행태snu-dhpm.ac.kr/pds/files/환의사(3)_인터넷과 의료... ·...

인 넷과 의료이용행태

2008년 6월 3일

의료관리학교실

김 윤

E-mail: yoonkim@snu.ac.kr

Magnitude of Use:Exponential Growth

v Internet health information seeking among of the internet users

n U.S.: 43%(1997)à63%(2000)

n Korea: 84.4% (2003)

한 보건사회연 원. 넷 건강정보 게 트웨 시스 개 .2003

Information Age Health Care

Eysenbach G. Consumer health informatics. BMJ 2000 320:1713-6.

Driving Forces

Growing need to equalise relationshipsbetween health professionals and lay people

Desire of most consumers to assume more responsibility for their health

Consumerism

Medical Knowledge

Emergence of evidence based medicine

Information Technology

Increasing availability of interactive information accessible to consumers

Effort to Effort to cut healthcare costscut healthcare costs by improving by improving patients' abilities to help themselves and make informed choicespatients' abilities to help themselves and make informed choices

Application Areas of the Internet

v Contentn Health web pages: health promotion on the internet

v Communicationn Online interaction with physicians

n E-mail, instant messaging, voice-over-IP (internet protocol)

v Community: online support groupn bulletin board system, mailing list, newsgroup/usenet group,

chatrooms

v E-Commercen Selling/buying products or services

v Electronic health record / E-disease management

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

C3E2C3E2

Application Areas of the Internet:

Contents

vWhy turning to web informationn Unmet needs of patients for information

n 48%: insufficient information

n 20%: unsatisfied with the information given

n 87%: want as much information as possible

vInternet patientsn Less satisfied with the amount of information

ü Turn to internet because of dissatisfaction

ü More dissatisfied with the information given when they realized much information is out there

n Reassure themselves

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

미국의소비자의료정보제공: MEDLINEplus

건강건강//질병질병 정보정보

약품약품 정보정보

학 과사전학 과사전

학 어사전학 어사전

료제공료제공 정보정보

MedlinePlus 제공정보: 질병중심정보

vMedlinePlus

n 질병정보

CHN(Canadian Health Network): 건강증진및질병예방관련정보

아비만에아비만에활동적활동적 삶삶

Application Areas of Internet:

Contents: Patients’ response

vPositive effectsn Strong relationship between internet use and both self-

efficacy and patient task behavior

n 92%: feel empowered to make decision

n 91%: help patients to talk to physicians

ü Having confidence to ask questions to physicians

vNegative effectsn 76%: conflicting medical information

n 31%: overwhelmed (information overload)

n 27%: confused about the right course of treatment

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

Application Areas of Internet:

Contents: Physicians’ response

vInformation is only “sometimes” correct

vWorsen patient-physician relationshipn In minority of cases (9%)

n Because of ü Feeling that patients challenge physicians’ authority

ü Requests which are not always appropriate

ü Interference with time efficiency

vTime spent discussing internet information has increased

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

64%

30%

19%

8%

7%

6%

37%

19%

22%

10%

10%

8%

5%

46%

17%

19%

64%

31%

Improved Understanding of a Condition*

Conducted Further Research on Condition*

Discussed Disease/Treatment* with Friend/Family

Made a Treatment Decision

Discussed a Disease or Treatment with Dr

Sought Further Info from Library

Made Dr Appointment

Altered Exercise or Eating Habits

Switched Prescriptions or Medicines

Repeat 2001MEDLINEplus Visitors(n=1455)

Repeat 2003MEDLINEplus EnglishVisitors (n=1938)

MedlinePlus 통한정보제공이미친영향

* Disease, condition, diagnosis, or treatment

Source question: Please indicate what has happened as a result of using information you obtained from MEDLINEplus today or in your most recent visit.

Impact of the Internet health information seeking in Korea

vActions after seeking health information on the web

n 82.7%: Discuss w/ family and friends

n 70.3%: Change in behavior

n 25.6%: Seek health care utilization

n 20.5%: Discuss w/ physicians

vOutcome

n 75%: Better understanding of a condition

n 52%: Change in life-style (eating, exercise, etc)

한 보건사회연 원. 넷 건강정보 게 트웨 시스 개 .2003

MedlinePlus

건강샘http://www.healthkorea.net

Quality Criteria

0%

20%

40%

60%

80%

100%

Accuracy Completeness Technicalcriteria

Readability

Yes

No

Partial

Result of systematic review on 79 studies on assessing the quality of health information for consumers on the WWW

Eysenbach G, Powell J, Kuss O, Sa ER. Empirical studies assessing the quality of health information for consumers on the World Wide Web: A systematic review. JAMA, 2002; 287: 2691-2700

인터넷건강정보질평가:우리나라와외국웹사이트비교

심각하거나 한

결점

* P<0.05 ** P<0.01 *** P<0.001

***

심각하지 않지만적 로 중 한

결점

미미한 결점

Using DISCERN evaluation protocol

아토피피부염환아에서비의료인주도의식이요법후발생한부작용 10례인제대학교일산백병원소아과학교실: 남승연, 조정일, 이종국

v 인터넷사이트에서 아토피피부염환자에대한무분별한식이요법이

광고, 권고되었다.

v 환아들은모두한인터넷사이트에서 권고하는식이요법을시행하였

다.

v 그내용은모유수유를하며모체와환아들에게 우유와계란을포함한

동물성단백질을제한하고현미, 현미찹쌀, 콩, 통밀, 보리, 조를혼합

한유동식과 감잎차, 매실농축액, 녹즙을섭취하도록하였다.

v 체중증가의실패는식이요법 시작시기연령이어릴수록, 시행한기

간이길수록뚜렷이나타났다. 대두/밀단백질에 대한높은감작율과

8명의환아에서저알부민혈증과 부종이보였다.

v 환아들은성장저하, 저단백질혈증, 식물성단백질에대한알레르기감

작증가등이관찰되었다.

Application Areas of Internet:

Communication

vE-mail communication between patients and physiciansn 6-9% patients n 1~5% physician (74% of them uses e-mail)

vReason for underuse of e-mail n Fear of increase demand on physician timen Difficulty in incorporating e-mail into daily work flown Concern over generation timely responsen Concern over inappropriate or urgent contentn Lack of reimbursement n Liability concern n Preferring face-to-face interaction

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

Internet Interventions:Good or Harmful?

v Type of Internet interventions n Smoking cessation n Cardiac and nutrition educationn Behavioral interventions for headache and weight lossn Pharmacy and augmentative services.

v Effectiveness of using the Internet intervention n Results of the systematically review of 10 comparative studies n All studies showed some positive effects on health outcomesn Lack of evidence: poor methodological quality of many studies

v Smoking cessation (Takahashi, 1999)n Before and after studyn Intervention: web information and daily e-mail supportn 52% (smokers) and 43% (heavy smokers) success rate for 12

months

Bessell TL, McDonald S, Silagy CA, Anderson JN, Hiller JE, Sansom LN. Do Internet interventions for consumers cause

more harm than good? A systematic review. Health Expect. 2002 Mar;5(1):28-37.

Application Areas of Internet:

Community

vVirtual community

n Definition: Social network formed in or facilitated through electronic media

n 22,000 support groups in the Health & Wellness section of Yahoo (Aug. 2003)

n Most of them are mailing list

vACOR (American Cancer Online Resources)

n Clearinghouse for mailing list

n 235 mailing list with 115,000 messages exchanged per day (Mar. 2003)

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

Application Areas of Internet:

Community

vMessages exchangedn Two pillars: information and supportn Mirroring findings from the literatures on face-to-face

self-help support group

vResearch opportunity:n Learn about preferences and experiences of

patientsn Rich source for understanding the experiences and

views of patientsn Analyze where and why gaps exist between

evidence-based medicine and consumer behavior and expectations

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

Application Areas of Internet:

Community

vAdvantage n Absence of geographic and transport barriersn Anonymity for stigmatizing, embarrassing, or sensitive

issuesn Increasing self-disclosuren Encouraging honesty and intimacyn Find peers online, even for rare disease

vDisadvantagen Considerable amount of noisen Negative emotions and lack of physical contact n Inaccurate or “non-evidence based” information

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

Application Areas of Internet:

Electronic Health Records (EHR)

vA longitudinal record of patient’s health and health care – from cradle to grave.

n Cf> EMR: Record of the periodic care provided mainly by one institution

vMedical record on the internet

n Empower consumers by putting health information into their hand

영국 NHS 평생전자건강기록

당뇨병 진단

문(1979)

염좌간호사 문(1983)

다 골절

병원 원(1993)

탈 수술

병원 원(1981)

파상풍접종

보건 문(1987)

가

지

지

PatientSite: Patient-centered communication, services, and access to information

v Information n Information asymmetry: medical knowledge – province of

medical professionals

n Patients want ü to learn more about health promotion, medical conditions, and

treatment

ü To access to their medical records, medications, allergies, problem lists, appointment history, test results

v Conveniencen Accustomed to “online convenience”: ordering airline tickets,

internet banking

n In healthcare, none of these conveniences are offered to consumers

n Leads to patient frustrations and inefficiency of healthcare

PatientSite: Patient-centered communication, services, and access to information

vHealthcare consumer needs

n Communication

ü Consult with their physicians about medical issues

ü Refill prescriptions

ü Make appointments

ü Look up test results

ü Find information about their problems

*Source: E-disease Management. FCG,2001.

정보기술 한 질병 시스E-disease Management

울혈성심부전관리: 시스템개요••값싸고값싸고 형형••매매 아아 환환 체중체중, ,

상증상상증상, , 기 상태에기 상태에한한 료료 수집수집

••정보정보 네트웍네트웍해해

로로 전전

••얻어진얻어진 정보정보하여하여

사례사례

울혈성심부전관리: Health Buddy

체중체중나나 ??

체중체중 얼 나얼 나었었 ??

에에 물물어났습 다어났습 다. . 짠짠

식식, , 수 취수 취줄 고줄 고 꼭꼭 약약

드드

숨숨 쉬기에쉬기에 어어정정

힘드힘드 ??

울혈성심부전관리: 평가

v입원n 절반으로감소

v응급실방문n 73% ▼

v진료비절감: 연간환자 1인당n $5,271

vROI (return on investment)n 200 %

Application Areas of the Internet

v Contentn Health web pages: health promotion on the internet

v Communicationn Online interaction with physicians

n E-mail, instant messaging, voice-over-IP (internet protocol)

v Community: online support groupn bulletin board system, mailing list, newsgroup/usenet group,

chatrooms

v E-Commercen Selling/buying products or services

v Electronic health record / E-disease management

Eysenbach G. The impact of the Internet on cancer outcomes. CA Cancer J Clin. 2003 Nov-Dec;53(6):356-71.

C3E2C3E2

Thank you