Although I have not posted about Pharmacists and the use of the Internet and I have not found many research on this topic,  it’s clear that these health professionals are playing an important role in healthcare. Therefore, they also have a role in relationship with the Internet, specially Community Pharmacists, who are probably the most accessible health professional and are daily dealing with all kind of patients. Health promotion, Health prevention, Health Literacy, patients’ education,… are just some of the fields where Community Pharmacists can encourage patients to become more engaged in their own health care or their relatives health care.

Following our analysis of the integration of Information and Communication Technologies into medical practice and into nursing practice, we have analysed Community Pharmacists. The specific objectives were to develop and characterise a typology of CPs based on their ICT utilization and to identify factors that can enhance or inhibit the use of these technologies.

Cluster one consists of CPs whose information needs place a greater emphasis on international and national information; on activities related to professional education and information from the Pharmacists Association as well as workplace and pharmaceutical industry. This group also emphasizes ICT use for activities such as information search, communication and the dissemination of information as well as for corporate activities. This group is thus referred to as representing ‘integrated Community Pharmacist’. The label is used descriptively in order to capture the sense that for this group ICT are a mundane and valued resource. Cluster two is characterised by notably different features to the previous one. The second profile represents those CPs placing less emphasis on ICT so are consequently labelled as ‘non-integrated Community Pharmacist‘.

Statistical analysis of the relationship between these profiles  revealed that ‘integrated Community Pharmacist‘ are more likely to start using Internet at an earlier stage, to consider it very useful, to use this tool on a daily basis, to have a blog and to consider Internet health information very relevant. No significance association related to age, gender or pharmacy ownership was found.

Further analysis of the relationship between the two profiles and the pharmacist-patient relationship resulted in ‘integrated Community Pharmacist‘ being more likely than ‘non-integrated Community Pharmacist‘ to recommend that patients go online to find health information and to have more patients that discuss such information during a consultation. ‘Integrated Community Pharmacist‘ are also more likely to believe that patients going online for health information improve their autonomy and their quality of life as well as improving both the health professional/patient relationship and  the pharmacist/patient relationship. Finally, ‘integrated Community Pharmacist‘ are more likely to be found on the Internet searching or providing advice on professional forums. Additionally, drivers for ICT use such as improving communication with other health care professionals and improvement in work productivity are likely to have a higher impact on ‘integrated Community Pharmacist‘ while barriers such as lack of training or lack of time are less likely to challenge them.

It was observed that factors related with ‘intensive use of Internet’ (every day), ‘emphasis on Internet for communication and dissemination’ as well as information needs from the Pharmacists Professional Association play a positive and significant role in the probability of being an ‘integrated Community Pharmacist‘. Recommending patients going on-line for health information and discussing or sharing patients’ Internet health information findings also have a positive and significant role.

Acknowledgements

The research reported is part of a broad study supported by Departament de Salut de la Generalitat de Catalunya (Catalonia Health Department) and directed by Prof. Manuel Castells. Survey launched is a result of collaboration between the Internet Interdisciplinary Institute at Open University of Catalonia and the Pharmacist Association of Barcelona (Col.legi Oficial de Farmacèutics de Barcelona).

We are planning to launch again our survey to Physicians, Nurses and Pharmacists with the collaboration of their Professional Associations of Barcelona. Therefore, we are redesigning the questionnaires and checking our multivariate analysis. Following the published paper entitled “The integration of Information and Communication Technology into medical practice”, we have send to a peer-review journal another paper focused on Nurses. Below you can find the main figures:

Table 5 revealed that cluster one (4.58%) is composed of those nurses who make greater use of ICT and the Internet for access to clinical and scientific information. The nurses within this cluster are also more likely to use ICT as a resource for publishing and international contact on national and international information. This first profile represents those nurses who place high emphasis on ICT in that it forms an integral part of their practice. This group is thus referred to as representing ‘Integrated nurses’. In other words, ICT and the Internet has become an important tool to be used in the delivery of care for the ‘integrated nurse’.

Cluster two (95.42%) is characterised by a distinctive set of features. The second profile represents those nurses who place less emphasis on ICT so that it is used to support their daily work only when required. This group are consequently labelled ‘Non-integrated nurses’.

Statistical analysis of the relationship between the two profiles (see Table 6 of the presentation) revealed that ‘Integrated nurses’ are more likely than ‘Non-integrated nurses’ to carry out research activities, to consider the Internet is ‘very useful’ to their nursing practice and to recommend that their patients use online health information. ‘Non-integrated nurses’ are more likely than ‘integrated nurses’ to be only engaged in delivering nursing care and to believe that patients use of online information will have little impact on their treatment their or understanding of their condition.

Finally, it was found that all the variables included have a significance explanatory power regarding the integration of ICT within nursing practice (see Table 7). It was observed that an ‘emphasis on international information’, performance ‘research activities’ and ‘the perception that health information available on the Internet’ was relevant to nursing played a positive and significance role in the probability of being an ‘Integrated nurse’.

Acknowledgements

The research reported is part of a broad study supported by Departament de Salut de la Generalitat de Catalunya (Catalonia Health Department) and directed by Prof. Manuel Castells. Survey launched is a result of a collaboration between the Internet Interdisciplinary Institute at Open University of Catalonia and the Nurses Association of Barcelona (Col·legi Oficial de Infermeres de Barcelona).

Lately, I have been checking systematic literature reviews about Chronic Disease Management, Remote Monitoring and Treatment and Information and Communication Technologies:

• Whitten, P. S., Mair, F. S., Haycox, A., May, C. R., Williams, T. L., & Hellmich, S. (2002). Systematic review of cost effectiveness studies of telemedicine interventions. Bmj, 324(7351), 1434–1437.
• Louis, A. A., Turner, T., Gretton, M., Baksh, A., & Cleland, J. G. F. (2003). A systematic review of telemonitoring for the management of heart failure. Eur J Heart Fail, 5(5), 583–590.
• Jaana, M., & Pare, G. (2007). Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. J Eval Clin Pract, 13(2), 242–253.
• Pare, G., Jaana, M., & Sicotte, C. (2007). Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc, 14(3), 269–277.
• Jaana, M., Pare, G., & Sicotte, C. (2009). Home telemonitoring for respiratory conditions: a systematic review. Am J Manag Care, 15(5), 313–320.

I do not want to reproduce all the abstract here,  but some common trends could be identified:

• Lack of cost-effectiveness analysis;
• Lack of Randomized Controlled Trials;
• Difficulties in extrapolating or comparing the results;
• Patients satisfaction and acceptance of the technology.

To sum up, following Pare et al. (2007) “Home telemonitoring of chronic diseases seems to be a promising patient management approach that produces accurate and reliable data, empowers patients, influences their attitudes and behaviors, and potentially improves their medical conditions. Future studies need to build evidence related to its clinical effects, cost effectiveness, impacts on services utilization, and acceptance by health care providers”.

Is not about TECHNOLOGY, is it?

I’m delighted to announce that the article entitled “The integration of Information and Communication Technology into medical practice” has been accepted and is already in press at the  International Journal of Medical Informatics. As soon as possible I will upload a pre-print version.

PREPRINT

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

ABSTRACT

OBJECTIVES:

To identify doctors’ utilization of ICT; to develop and characterise a typology of doctors’ utilization of ICT and to identify factors that can enhance or inhibit the use of these technologies within medical practice.

METHODS:

An online survey of the 16,531 members of the Physicians Association of Barcelona who had a registered email account in 2006 was carried out. Factor analysis, cluster analysis and binomial logit model were undertaken.

RESULTS:

Multivariate statistics analysis of the 2199 responses obtained revealed two profiles of adoption of ICT. The first profile (38.61% of respondents) represents those doctors who place high emphasis on ICT within their practice. This group is thus referred to as ‘integrated doctors’. The second profile (61.39% of respondents) represents those doctors who make less use of ICT so are consequently labelled ‘non-integrated doctors’. From the statistical modelling, it was observed that an emphasis on international information; emphasis on ICT for research and medical practice; emphasis on information systems to consult and prescribe; undertaking teaching/research activities; a belief that the use of the Internet improved communication with patients and practice in both public and private health organizations play a positive and significant role in the probability of being an ‘integrated doctor’.

CONCLUSIONS:

The integration of ICT within medical practice cannot be adequately understood and appreciated without examining how doctors are making use of ICT within their own practice, organizational contexts and the opportunities and constraints afforded by institutional, professional and patient expectations and demands.

Please cite this article as:

Lupiáñez-Villanueva, F., Hardey, M., Torrent, J., & Ficapal, P. (2010). The integration of Information and Communication Technology into medical practice. Int J Med Inform, 79(7), 478–491.

PUBMED link

Lately, I have been checking and reading some scientific papers about health communication from:

• Journal of Health Communication: International Perspectives
• Health Communication
• Patients Education and Counselling

The aim is to write a paper based on the presentation done with Michael Hardey:

The purpose of this paper is  to identify how health professionals view public use of the Internet and whether new forms of communication are emerging with the following objectives:

• To identify the utilisation, experience, expertise, barriers and expectations that doctors, nurses and community pharmacists have with the Internet and the email.
• To identify the experience and expectations that doctors, nurses and community pharmacists have with patients using the Internet.
• To identify factors that can enhance the integration of the recommendation of health information available on the Internet and the email within the health professional / patients relationship.

Any reference, suggestion, recommendation… about the presentation will be appreciated.

On 26th October I have the opportunity to act as a moderator in a symposium called Communication in health 2.0, organized by the Institute for Continuing Education (IDEC) and the University of Pompeu Fabra’s Science Communication Observatory (OCC). First of all, I would like to thank Vladimir de Semir, Gemma Revuelta and Clara Armengou for their invitation and their organization of the symposuum. I really think that University has a role as a hub to disseminate and research about this topic in collaboration with the rest of the actors (industry, healthcare providers, professionals, Government,…).

Act as a moderator gave me the opportunity to work on the Health Communication field as a framework of part of the research I have been doing and develop the first step towards the conceptualization of Health Mass-Self Communication.

Yesterday I had the pleasure to attend the defence of Ismael Peña‘ thesis Measuring digital development for policy-making: models, stages, characteristics and causes, “which deals about the digital economy and whether governments should help in its development for it might have a positive impact on the real economy and on the society at large”.

Dissertation supervisor: Tim Kelly

Composition of the committee:

President: Tim Unwin (University of London)
Secretary: Joan Torrent Sellens (UOC)
Members: Robin Mansell (London School of Economics)
Bruno Lanvin (INSEAD)
Laura Sartori (Università di Bologna)

Substitutes:
Gustavo Cardoso (Instituto Superior de Ciências do Trabalho e da Empresa)
Rosa Borge Bravo (UOC)

CONGRATULATIONS Dr. Peña-López. I’m proud to work with you in the same research group I2TIC.

I have read Nijland, N., van Gemert-Pijnen, J. E. W. C., Boer, H., Steehouder, M. F., & Seydel, E. R. (2009). Increasing the use of e-consultation in primary care: Results of an online survey among non-users of e-consultation. International Journal of Medical Informatics, In Press, Corrected Proof.

Abstract

Objective
To identify factors that can enhance the use of e-consultation in primary care. We investigated the barriers, demands and motivations regarding e-consultation among patients with no e-consultation experience (non-users).

Methods
We used an online survey to gather data. Via online banners on 26 different websites of patient organizations we recruited primary care patients with chronic complaints, an important target group for e-consultation. A regression analysis was performed to identify the main drivers for e-consultation use among patients with no e-consultation experience.

Results

In total, 1706 patients started to fill out the survey. Of these patients 90% had no prior e-consultation experience. The most prominent reasons for non-use of e-consultation use were: not being aware of the existence of the service, the preference to see a doctor and e-consultation not being provided by a GP. Patients were motivated to use e-consultation, because e-consultation makes it possible to contact a GP at any time and because it enabled patients to ask additional questions after a visit to the doctor. The use of a Web-based triage application for computer-generated advice was popular among patients desiring to determine the need to see a doctor and for purposes of self-care. The patients’ motivations to use e-consultation strongly depended on demands being satisfied such as getting a quick response. When looking at socio-demographic and health-related characteristics it turned out that certain patient groups – the elderly, the less-educated individuals, the chronic medication users and the frequent GP visitors – were more motivated than other patient groups to use e-consultation services, but were also more demanding. The less-educated patients, for example, more strongly demanded instructions regarding e-consultation use than the highly educated patients.

Conclusion
In order to foster the use of e-consultation in primary care both GPs and non-users must be informed about the possibilities and consequences of e-consultation through tailored education and instruction. We must also take into account patient profiles and their specific demands regarding e-consultation. Special attention should be paid to patients who can benefit the most from e-consultation while also facing the greatest chance of being excluded from the service. As health care continues to evolve towards a more patient-centred approach, we expect that patient expectations and demands will be a major force in driving the adoption of e-consultation.

Summary points

What was already known on the topic?

• The increased public interest in medical information regarding health issues are driving forces for the growth of health services on the Internet. However, the growth of e-consultation in primary care has been minor.
• Access to healthcare and information technology is often most difficult for those populations who need it most. E-consultation can be beneficial for certain patient groups, such as frequent GP visitors and chronic users of medication. Yet, it is unclear whether access to e-consultation is most difficult for these populations.

What did this study add to our knowledge?

• Non-use of e-consultation was primarily due to lack of availability among GPs and to information deficits among patients, such as unawareness of the existence of the service and the possibilities of e-consultation. Proper education and instructions are necessary to increase the use of e-consultation.
• Patient groups who were most motivated to use e-consultation e.g., elderly patients, less-educated patients, chronic medication users and frequent GP-visitors, perceived the greatest barriers towards econsultation.
• Web-based triage systems may be promising, because this study indicates that patients are motivated to use such systems for primary evaluation of medical complaints and for self-care advice.

Again, the results of the empirical research revealed the gap between the potencial of ICTs uses in healthcare and the facts that shape these uses. The inverse care law is still working in the transition of healthcare systems to Network Society.

I would like to disseminate a paper entitled Knowledge, networks and economic activity: an analysis of the effects of the network on the knowledge-based economy written by Joan Torrent, director of ICTs Interdisciplinary Research Group (i2TIC), brand new research group I belong to.

This paper contextualises the disruptive change of the transition to a knowledge-based economy and discusses the social sciences postulations with regards to this phenomenon. Once the general context is explained, the article focuses on the microeconomic foundations, understanding knowledge as an input and as a commodity. Finally, after discussing the microeconomics of knowledge, the paper tackles network externalities and their  impact on economic functions and market structure.

Abstract

The progressive consolidation of a knowledge-based economy has caused network effects to become a focal point of analysis into the changes in behaviour evinced by economic agents. This article analyses the changes in production and demand for knowledge commodities arising from network externalities. The analysis reveals two distinct patterns of behaviour in knowledge-based economic activity. Observable knowledge commodities are governed by the effect of direct and indirect network externalities. Also, their demand curve and business strategy depend on new-user entry (marginal value) and the relative size of the network. However, tacit knowledge commodities are governed by learning network externalities and their demand curve and business strategies are dependent on the value generated by the addition of the goods themselves to the network (intrinsic value).

This paper could help towards a better understanding of  health care systems within the network society.