By Emily J. Tipping

Published January 2001

• React to this article in the Discussion Forum.

David Miller, Ph.D., is associate dean and associate professor at the University of Pittsburgh’s Graduate School of Public and International Affairs. He directed a Consumer Health Information in Allegheny County study to determine how consumers use technology to seek information on health care.

PND: Why was the study done, and how was it conducted?

DM: The amount of information that exists locally on health care consumers and their access points to information was really unknown. The Jewish Healthcare Foundation wanted to establish a baseline of information utilization for the region that could be used to make policy recommendations about the original data and set in place the opportunity to have that data updated over time to see what changes were occurring within the region. The study was a telephone survey of about 1,000 residents of Allegheny County that looked at their pursuit of information about their health care, primarily through technology. So the question was whether or not residents of Allegheny County were utilizing some of the new technologies, such as the Internet, for obtaining health care information.

PND: What are some of the major findings of the study?

DM: We found that health care consumers in western Pennsylvania were accessing the Internet at about the same level as we’ve seen from other studies across the United States in health care utilization. So, our population is not atypical. Secondly, and I think probably most importantly, it demonstrated that, like in other areas of the country, there is a new health care consumer emerging—individuals who no longer solely rely on their health care provider for information about their health care. We defined three types of health care consumers. The first type were what we referred to as "Traditional Information Seekers," which was about half of the population. This group relies almost exclusively on their health care provider for information and tends to be made up of older and younger individuals who have not experienced an acute or chronic health problem. The second group, which we called "New Information Seekers," made up about a quarter of our sample and relies on both the health care provider and other sources of information on their health condition. This group is made up of younger people and people who may have experienced acute or chronic health problems, suggesting that, at least demographically, that the population of New Information Seekers will probably grow significantly in the future while the traditional health care consumers will probably decrease in numbers. A third group defined as "Non-Seekers" did not seek health care information from any source.

PND: How are these findings significant for physicians?

DM: The physician, as the primary health care provider, is now in a position of having consumers who are much more knowledgeable about their health care than they have been in the past. This is not to say that the physician is being replaced. Indeed, even for these New Information Seekers, the most reliable source of information is their health care provider. Even the New Information Seekers find the traditional patient-physician relationship and information exchange to be the most preferable form of information. There are a couple of interesting points as far as the physicians are concerned. One is that physicians generally are providing health care consumers with traditional forms of supplemental information in the form of pamphlets, handouts and references to old sources of information, when the health care consumer isn’t using that information. So the type of suggestions physicians are making in terms of where patients can get supplemental information is outdated. That’s not where a lot of consumers are going. About three percent of our population in the survey remembered being referred to an Internet site by a physician as part of the consultation and about 51 percent actually go to the Internet. The movement of these New Information Seekers to the Internet is not because they’ve been referred there by their physician. Health care providers are not the stimulus for this utilization of the Internet. One of the hardest issues and most interesting pieces of the survey is that health care consumers are not necessarily sharing that information with their health care provider when they get together. There is information-seeking going on, but the health care consumer hasn’t figured out how to integrate that into the conversation with the health care provider, or the health care provider hasn’t figured out how to elicit that information from the consumer. There’s a real breakdown in communication between the physician and the consumer that needs to be changed.

PND: How can physicians apply these findings in their practice?

DM: At this point there’s very little regulation, licensing or peer review of websites. So, for a physician to be making recommendations on where to be looking on the Internet is not an easy task. On the one hand we have consumers looking on the Internet and on the other hand we have health care providers that don’t have a particularly good way of being able to make recommendations about the Internet because nobody’s sure of the quality of the site. This is a real problem. There probably ought to be a new kind of a job developed within the health care community linking what the physician is trying to do as far as transfer of information to patients with what are the appropriate sites for these patients to be looking at on the Internet. We don’t really have a lot of quality control on the search for information by health care consumers. It raises a whole set of institutional problems. We didn’t do a survey of physicians or other health care providers from the standpoint of asking them, for instance, "Did you recommend sites?" So, we could have a lot more recommending of websites going on than consumers are remembering. We only have half of that picture with this particular study.

PND: Is it realistic to expect that physicians will make use of these findings?

DM: I would hope so, as a growing population of their patients is probably searching for health care information on the Internet. More physicians could just spend time saying to a consumer, "It’s okay for you to look on the Internet and tell me what you found." I think we found in the survey that consumers are nervous or reticent about sharing that information without knowing what type of response they would get from their physician. Merely getting patients to share this kind of information searching could be a very positive development. The second thing that the physician community has to deal with is what type of quality assurances are going on with the Internet. Information seeking is going on, and people may not be going to quality sites. Physicians should be asking how to get validation of the accuracy of this information.

PND: What are some barriers that make it difficult to validate website information and improve the way physicians and patients utilize technology?

DM: Widespread utilization of the Internet by physicians as a form of communication with patients, either in the recommending of sites or e-mail exchange, is a new and unexplored area that raises as many new issues as it solves. Introducing it as a new form of communication has to occur one painfully slow step at a time. Our greatest barrier is simply the absence of the underlying support systems, such as better ways to validate web sites and agreed upon protocols for e-mail correspondence, that facilitate physician and patient communication through this new medium. As those systems are developed, utilization will increase.