Five years of poisons information on the internet: the UK experience of TOXBASE

Introduction

In 1999, the UK adopted a policy of using TOXBASE, an internet service available free to registered National Health Service (NHS) departments and professionals, as the first point of information on poisoning. This was the first use worldwide of the internet for provision of clinical advice at a national level. We report the impact on database usage and NPIS telephone call loads.

Methods

Trends in the pattern of TOXBASE usage from 2000–2004 are reported by user category. Information on the monographs accessed most frequently was also extracted from the webserver and sorted by user category. The numbers of telephone calls to the National Poisons Information Service (NPIS) were extracted from NPIS annual reports.

Results

Numbers of database logons increased 3.5 fold from 102 352 in 2000 to 368 079 in 2004, with a total of 789 295 accesses to product monographs in 2004. Registered users increased almost tenfold, with approximately half accessing the database at least once a year. Telephone calls to the NPIS dropped by over half. Total contacts with NPIS (web and telephone) increased 50%. Major users in 2004 were hospital emergency departments (60.5% of logons) and NHS public access helplines (NHS Direct and NHS24) (29.4%). Different user groups access different parts of the database. Emergency departments access printable fact sheets for about 10% of monographs they access.

Conclusion

Provision of poisons information by the internet has been successful in reducing NPIS call loads. Provision of basic poisons information by this method appears to be acceptable to different professional groups, and to be effective in reducing telephone call loads and increasing service cost effectiveness.     

Representations of heart failure in Internet patient information

Title.  Representations of heart failure in Internet patient information.
Aim.  This paper is a report of a study which examined representations of heart failure in Internet patient information.
Background.  The Internet is a popular tool for sourcing health information and has been shown to benefit people with chronic conditions. Nurses as users and producers of Internet health information need to be critical of the information they provide and how this information is portrayed, to support patient knowledge development and decision-making.
Method.  A critical discourse analysis approach was used to examine representations of heart failure in a range of Internet texts. Data were collected from eight websites over 5 days in July 2006.
Findings.  The two major discursive representations evident in the heart failure texts were labelled 'living with heart failure' and 'biomedical' discourses. While both discourses were evident in all of the Internet sites, most sites privileged the biomedical discourse. Absences from the Internet information included the visibility and role of nurses along with emotional and spiritual dimensions of heart failure.
Conclusion.  Nurses should take individual needs into consideration and be able to critique websites before suggesting appropriate sites to patients. Nurses and consumers can enhance the quality of websites by becoming involved in their development to ensure that all factors that affect health are included, such as the emotional and spiritual aspects of living with heart failure and not just topics that are important within a biomedical view of health.     

Button battery exposures in Australian children: a prospective observational study highlighting the role of poisons information centres

Context: Button battery ingestion is a worldwide problem, with evidence of increasing harms and deaths in recent decades. Australian Poisons Information Centre (PIC) experience includes cases of treatment delay due to lack of healthcare professional recognition of risks, and/or lack of local resources. This study aims to characterise Australian button battery exposures, focusing on exposure circumstances, and preventable health system shortcomings.

Methods: A prospective observational study of button battery exposure calls to New South Wales PIC, November 2015–May 2017, using a follow-up survey to obtain outcome data and additional details. Survey data was combined with nationwide PIC data over the same period.

Results: Australian PICs were consulted on 578 exposures over the 19-month study period, including 506 paediatric cases. The median (IQR) age for the paediatric cases was 23 months (14–36 months). Where the source was identified, batteries came from toys in 26% of cases, with hearing aids, watches, and remote controls being other common sources. Children in outer regional, remote and very remote areas were overrepresented, and 15 cases were referred to a different hospital due to X-ray facilities being unavailable at their nearest hospital. We identified inconsistent triage from a range of first responders, and knowledge gaps regarding button battery dangers amongst some healthcare professionals.

Discussion: Button battery exposures are a common call to Australian PICs. This study highlights a potential role of education campaigns, professional guidelines, and child-resistant battery compartments in toys and household devices. PICs calling ahead to ensure X-ray availability/diversion to a different hospital likely reduced delays for this time-critical exposure.

Conclusions: Button battery exposures continue to be a problem in Australia. Data collected by PICs can provide useful information for public health and product safety initiatives. A PIC-led protocol to direct initial medical management of button battery exposures could reduce delays and improve outcomes.     

Data information and knowledge: the health informatics model and its role in evidence-based medicine

The health informatics model consists of three essential parts: data, information and knowledge. These elements are arranged in a hierarchy, with data at the base of the model providing the basis for establishing information and leading in turn to the potential generation of knowledge. The informatics model converges closely with the principles, aims and tasks of evidence-based medicine (EBM), particularly as they relate to searching, appraising, reviewing and utilizing information and research. The development of health informatics today has its origins in the growth of statistics in the 18th and 19th centuries. As a new and growing discipline, statistics burgeoned amidst the challenge of measuring, monitoring and ultimately governing societies in the throes of massive change and expansion. The governance role embraced by statistics in the past resembles many aspects of the role ascribed to audit, quality assurance and EBM today. There are some deep-seated paradoxes within the field of health informatics. The informatics model posits an oversimplified and linear progression of data to information and knowledge. Health informatics may involve the spreading and dissemination of information but this should be seen as only a part, not the equivalent, of the complex process of generating knowledge.     

An Internet primer for emergency physicians: Part I

The growth of the popularity of the Internet is nothing short of phenomenal. Increasingly, valuable medical information is becoming available on line for physicians and health consumers alike. Physicians can clearly benefit personally and professionally by obtaining access to the Internet. The purpose of this article is to introduce the Internet to physicians who have limited experience with this new medium. It discusses the concept of the Internet, the necessary computer components and modem for on line connection, and the various types of Internet Service Providers. A glossary is also provided to explain some of the most common terminology used in the Internet culture.     

Reducing disparities in the access and use of Internet health information. a discussion paper

Internet health information is rated highly by users and is used to compensate for gaps in health information provided by health professionals. Greater understanding of health issues and changes to personal health management has been reported as a consequence of Internet use. However, there are significant disparities in the access and use of Internet health information linked to income, education and ethnicity. In this paper a case is presented that on-line health information particularly benefits the already privileged in terms of health care; well-educated people with access to economic resources. Several intervention points are suggested to improve Internet health information accessibility and use for all population groups. Interventions at an institutional level include improving equity of Internet access through the provision of free services at strategic sites and improving the readability and cultural acceptability of health information. Individually focused interventions involve skill development to enable effective navigation of Internet sites, identification of patient and families' information needs and support to develop evaluation skills. The effectiveness of these interventions in reducing disparities is reliant on nurses and other health professionals' expertise in accessing, evaluating and using Internet health information in their clinical practise. On-line health information is a powerful medium for quick and dynamic knowledge distribution. The challenge for nurses and other health professionals is directing that knowledge to the groups most disadvantaged in the current health care systems, with an agenda of reducing inequalities in access to health information.     

The use of computers and the Internet as a source of health information for people with disabilities.

It becomes increasingly obvious that computers and the Internet will play a prominent role in healthcare in the 21st century in America. The use of these tools in telecommunications technology to inform and educate has resulted in the emerging field of interactive health communication (IHC). The value of this new field is heightened by its potential to make health-related information and services more accessible to vulnerable populations such as people with disabilities. The assessment of user needs is one of the first activities necessary in the development of IHC applications. This article reports our findings from a survey conducted as the first step in developing a program of interactive health applications for people with disabilities resulting from brain and spinal cord injuries. A rehabilitation center conducted a 3-year retrospective survey of patients who had completed rehabilitation from brain or spinal cord injury. The survey found that 73% of respondents surveyed had access to and used computers, and 68% had access to the Internet. Our findings show that people with disabilities are using computers and the Internet, suggesting these tools' potential as a medium for the dissemination of health-related information and services for this underserved population. Further findings and key issues related to IHC design and application are discussed.     

Nurses and Internet health information: a questionnaire survey

AIM: This paper is a report of a study to identify the extent of postgraduate nursing students' information literacy skills in relation to electronic media and health information and barriers to accessing this information. BACKGROUND: The Internet is a key source of information for a significant group of patients. However, there is evidence of quality issues with some Internet health information sites. Nurses need to be aware of the range and quality of online health information so as to assist patients and families to locate and evaluate relevant and current information. METHOD: A questionnaire designed to collect quantitative and qualitative data was posted to a convenience sample of all students enrolled in a postgraduate nursing programme in December 2005. The response rate was 55.1% or 123 responses. RESULTS: Most respondents had Internet access at home and work and believed that access to online health information resources had improved their practice. However, some had difficulties in accessing computers at work and insufficient time to search for online health information. Concern was expressed about the quality of online information, but the majority of respondents did not assess patient use. Frequent users of online resources were more likely to assess patient use. CONCLUSION: The development of nursing competencies in accessing and using online resources is a key precursor to supporting patients and families' use of the medium. Access to Internet resources at work, along with training and time for searching, is necessary for the development of skills enabling effective use of information technology.     

GP preferences for information systems: conjoint analysis of speed,reliability, access and users

Rationale, aims and objective To elicit the preferences and trade‐offs of UK general practitioners about key features of health information systems, to help inform the design of such systems in future. Methods A stated choice study to uncover implicit preferences based on a binary choice between scenarios presented in random order. Participants were all 303 general practice members of the UK Internet service provider, Medix who were approached by email to participate. The main outcome measure was the number of seconds delay in system response that general practitioners were willing to trade off for each key system feature: the reliability of the system, the sites from which the system could be accessed and which staff are able to view patient data. Results Doctors valued speed of response most in information systems but would be prepared to wait 28 seconds to access a system in exchange for improved reliability from 95% to 99%, a further 2 seconds for an improvement to 99.9% and 27 seconds for access to data from anywhere including their own home compared with one place in a single health care premises. However, they would require a system that was 14 seconds faster to compensate for allowing social care as well as National Health Service staff to read patient data. Conclusions These results provide important new evidence about which system characteristics doctors value highly, and hence which characteristics designers need to focus on when large scale health information systems are planned.     

Primary health‐care nurses and Internet health information‐seeking: Access,barriers and quality checks

Online information is a critical resource for evidence‐based practice and patient education. This study aimed to establish New Zealand nurses' access and evaluation of online health information in the primary care context using a postal questionnaire survey; there were 630 respondents from a random sample of 931 nurses. The majority of respondents were satisfied with work access to online information (84.5%, n = 501) and searched for online information at least several times a week (57.5%, n = 343). The major barrier to online information seeking was insufficient time, but 68 respondents had no work online information access. The level of nursing qualification was significantly correlated with computer confidence and information quality checking. A range of information evaluation approaches was used. Most nurses in study accessed and evaluated Internet information in contrast to the findings of earlier studies, but there were barriers preventing universal integration into practice.     

The impact of information technology on the performance of clinical pharmacy services

Electronic patient records are now being developed to assist in the clinical management of patients within secondary care. This paper reviews how various types of information technology used in these electronic patient records can improve the performance of clinical pharmacy services. The different levels of information technology support for some of the main aspects of clinical pharmacy services are described. How the impact and outcome of information technology support for these services should be evaluated are discussed. The human and technological factors that must be considered to ensure that the implementation succeeds and the potential benefits are realized are examined.     

Searching health information via the web: Hong Kong chinese older adults' experience

OBJECTIVE AND SAMPLE: This paper reports on the learning experience of 88 Chinese older adults who attended a health Web-navigating workshop. DESIGN: Through a 3-hr training workshop, participants were guided to browse through seven health Web sites that provide authoritative health information by the Hong Kong government, academic institutions, or professional bodies. METHODS: Upon completion of the workshop, an evaluation was made of the participants' confidence in navigating health Web sites by themselves at home and in utilizing the health information sources. RESULTS: The findings indicated that participants' confidence in seeking health information via the Internet was not associated with their age, educational level, or experience of using computers before the workshop but was significantly associated with their satisfaction with the workshop (p<.05). Significant change of source of health information was noted at follow-up, suggesting that the workshop was successful. CONCLUSIONS: Implications of the results for running health Web-navigating programs among Chinese older adults are discussed.     

Making the case for a clinical information system: the chief information officer view

Adequate decision support for clinicians and other caregivers requires accessible and reliable patient information. Powerful societal and economic forces are moving us toward an integrated, patient-centered health care information system that will allow caregivers to exchange up-to-date patient health information quickly and easily. These forces include patient safety, potential health care cost savings, empowerment of consumers (and their subsequent demands for quality), new federal policies, and growing regional health care initiatives. Underspending on health care information technologies has gone on for many years; and the creation and implementation of a comprehensive clinical information system will entail many difficulties, particularly in regard to patients' privacy and control of their information, standardization of electronic health records, cost of adopting information technology, unbalanced financial incentives, and the varying levels of preparation across caregivers. There will also be potential effects on the physician-patient relationship. Ultimately, an integrated system will require a concerted transformation of the health care industry that is akin to what the banking industry has accomplished with electronic automation. Critical care units provide a good starting point for how information system technologies can be used and electronic patient information collected, although the robust systems designed for intensive care units are not always used to their potential.