Catching the Web-Casting Wave

Abstract

The Charleston Area Medical Center (CAMC) in Charleston, West Virginia has embraced new media technologies to raise the bar on Web-based consumer information. This paper will detail CAMC's initiative in the area of interactive, Web-based consumer health learning using Web casting. CAMC has learned how to put their video programs on the Internet to teach people how to make the best health decisions. The professionals at CAMC are pushing the limits of what can be done with health information on the Internet.     

Assessment of school-based health centers in a rural state: the West Virginia experience.

PURPOSE: To assess the capability of school-based health centers (SBHCs) to provide access to health care for rural youth. METHODS: Review of annual patient records from SBHCs in West Virginia. Ten of 24 SBHCs in West Virginia in operation from July 1994 to June 1997 were selected for the study. Enrollment and utilization rates were generated for each site. A comparison was made between rates of enrollment, utilization, and annual visits among youth with private insurance, those covered by Medicaid, and youth without insurance. Rural and urban SBHCs within West Virginia were compared based on enrollment, utilization, and visit rates. The diagnostic categories were analyzed. Finally, enrollment rates, utilization rates, and insurance status for the West Virginia SBHCs were compared with national norms. RESULTS: Enrollment rates rose steadily during the study period from 27% in Year 1 to 64% by the end of Year 3. The utilization rate was 67% in Year 3. The youth with either Medicaid or no insurance comprised 52% of enrollees, but they accounted for 63% of all visits. West Virginia SBHCs have a higher rate of Medicaid users than the national average for SBHCs, and the annual visit rate for West Virginia youth is higher than the national average for nonmetropolitan adolescents. The enrollment rate of 64% is slightly higher than the national average for SBHCs. Within West Virginia, the enrollment rate in rural schools was significantly higher, 86% compared to 46% (p < .001), and the utilization rate was 70% in rural centers compared to 63% in the urban centers (p < .001). CONCLUSION: When SBHCs are available in rural areas, students use them. In West Virginia, SBHCs have contributed to providing access to health care for rural youth.     

Improving Health

Abstract

The Internet provides a ready source of patient education handouts specific to certain diseases or conditions. Patients and consumers can obtain clear, concise, and reliable information about their diseases or conditions and follow-up instructions for procedures and treatments. Patient education on the Internet can support patients or consumers in making informed health care decisions. Available day and night, patients can access this information at their convenience when they are most interested in learning. Included in this article are selected and annotated resources for locating patient education materials. Also included are Internet sites to locate materials for low literacy patient education.     

Getting Acquainted with Support and Self-Help Groups on the Internet

Abstract

The combined influence of the consumer health care movement, economics, and the communications revolution (specifically the Internet) promise to radically influence the manner in which the health care industry provides services to the American public. These forces are expected to spawn a more sophisticated consumer who will ask questions, collaborate in treatment options, and readily explore all the alternatives before making a decision. The near limitless possibilities for consumers to network using the electronic resources of the Internet are in the earliest stages of development. The purpose of this article is to briefly define the purpose of support or self-help groups, provide information on how to access them through the Internet, and offer suggestions for criteria that consumers may want to consider in determining the quality and value of these groups.     

Quality Assurance in eHealth for Consumers

Abstract

As millions of consumers turn to the Internet for health information, it is imperative that consumer health librarians teach them the skills needed to find trustworthy health information. This article examines important quality criteria for consumer health Web sites and reviews some top health Web sites that demonstrate quality.     

Depressive symptoms in rural West Virginia: labor market and health services correlates

The prevalence and socioeconomic correlates of depressive symptoms in rural West Virginia were assessed. A random-digit-dialed telephone interview was administered to a community-dwelling sample of adults, ages 18 to 64, residing in the 40 rural counties of the Appalachian State of West Virginia. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Overall rates of depressive symptoms were substantially higher than in the nation as a whole. Gender differences were lower than expected due to a high rate of depressive symptoms among men. Depressive symptoms were inversely associated with higher socioeconomic position. One-third of those who described themselves in "good mental health" reported depressive symptoms. About half who reported depressive symptoms had never seen a mental health professional or a physician for mental health problems. Efforts to increase awareness and access to mental health services are needed to promote the mental health of rural West Virginian populations.     

Finding and Evaluating Medical and Health Information on the Internet

Abstract

With the increase in accessibility of Internet connections for the public, there is more and more opportunity for consumers to assimilate vast amounts of health and medical information. The purpose of this article is to provide those consumers with some of the basics needed in finding quality health and medical information and distinguishing the mediocre from the trash. Elementary Internet terminology and some fundamental searching techniques, helpful for information retrieval, are provided. Five major criteria for evaluation of information are presented along with suggested questions for use in the process. Interpreting the various segments of the URL is also covered, along with examples of common Internet domains. Some Internet sites are included for more exploration and study of the topics considered in the article.     

Improving the Quality of Health Information on the Internet

Abstract

The Internet Healthcare Coalition (IHC), a nonprofit organization, believes it is possible to improve the quality of health information on the Internet without imposing new regulations and laws that limit the freedom of information providers or consumers. This article traces the history of the grass-roots development of the IHC beginning with an October 1996 FDA-sponsored public meeting. An online call to action led to the creation of the MEDWEB-MASTERS-L e-mail discussion group where important issues were debated and a community of interest developed. Subscribers felt it was important to meet in person during June 1997. At that time, it was resolved to create a coalition of health professionals, patients, industry, publishers, and Web developers with a common goal of promoting improved Internet health resources through education and self-regulation. The IHC is currently involved with efforts to help consumers and governments control health fraud on the Internet without destroying the Internet's ability to provide useful and legitimate health information. The Coalition plans to be an educational resource to support many independent efforts by members to improve the quality of health information on the Internet. In October 1998, it plans to hold its first annual meeting.     

Health Care Services for HIV-Positive Substance Abusers in a Rural Setting: An Innovative Program

ABSTRACT

Agencies that deliver health care services to HIV-positive substance abusers living in rural areas of the United States face particular treatment challenges and barriers to care. Rural consumers of HIV/AIDS health care–related services identified long travel distances to medical facilities, lack of transportation, lack of availability of HIV-specific medical personnel, a shortage of mental health and substance abuse services, community stigma, and financial problems as leading barriers to access to care. This article discusses barriers to care for rural HIV-positive substance abusers, and challenges for rural health care providers. In addition, it presents a case study of Health Services Center, a model program that has devised innovative practices in the delivery of health care services to HIV-positive substance abusers in rural northeastern Alabama.     

Healthy Pets: Web Sites to Help You Make Wise Health Care Decisions for Your Pet

ABSTRACT

As the number of pets and pet owners continues to increase in the United States, more and more people are becoming consumers of health information for their pets. Although the veterinarian continues to be the primary source of medical information for pet owners, many are turning to the Internet to begin their search for information or to find additional information that will assist them in making health care decisions about their pets. The types and quality of information available on the Internet about a pet's health varies greatly, and it is imperative that the pet owner finds high quality, unbiased, and up-to-date information in order to make wise decisions. This article briefly reviews the types of sites available and presents examples of high quality sites for the savvy pet owner.     

Information superhighway or information traffic jam for healthcare consumers?

The phenomenal development and growth of the information superhighway over the past few years has brought with an ever-increasing number of sites associated with health care. At the same time, community access to the Internet and multimedia technology has allowed greater access to healthcare sites by consumers wishing to find healthcare information relevant to their needs. The Internet has greater potential for improving the healthcare knowledge of the community, especially in remote areas or in parts of the community that have limited access to community health infrastructure. However, most of the current development of healthcare sites has focused on the needs of healthcare professionals rather than consumers. Indeed, with the volume of information available over the Internet, it is easy to spend hours browsing through a maze of sites with information that often is fragmented, incomplete, or only accessible with a password. Once a relevant site is located, the information often is presented as vast amounts of text with possibly some graphics. It appears little consideration is given during the development of web sites to the actual presentation of the information. For the full potential of the information superhighway to be realized in relation to health care, more consideration should be given during the development stages of web sites to how the information is presented and how to make access more streamlined.     

Policy barriers for advanced practice nurses in rural health care

ObjectivesThe objective of this paper was to examine rural health access to care, barriers to practice for Advanced Practice Nurses (APNs) in rural health, explore solutions, and arrive at a policy change that would improve rural citizens′ access to health care. This policy change should improve access to care, be cost-efficient, and have ease of implementation.MethodsMethods used for research included online health care journals, original research, and government statistics and websites. Sources were PubMed, Google Scholar, state Boards of Nursing publications including Scope of Practice statutes, and Rural Health Associations′ publications.ResultsBackground information and evidence was gathered, and 3 alternatives were explored: (1) Increasing incentives to practitioners to practice in rural areas, (2) Removing regulatory barriers to practice for APNs in rural health, and (3) Funding original research to determine optimal provider mix in rural health care. Advantages and disadvantages to these alternatives were examined with respect to population benefit, cost-effectiveness, administrative feasibility, and resource allocation equity. The 2nd alternative was determined to be the most effective.ConclusionAccess to health care for rural citizens is significantly worse than for urban dwellers, and the current methods of improving it are inadequate. The situation will be worsened by the projected shortage of primary care providers in the future, and therefore action to improve this is imperative. This situation can be greatly improved by removing barriers to practice for APNs to enable them to better provide care in rural areas, thus increasing rural citizens′ access to health care.     

AHEC in West Virginia: A Case Study

This case study describes the area health education centers (AHEC) program in West Virginia, spanning 30 years from a first-generation project at Charleston in 1972 (AHEC 1) to a newly funded statewide program (AHEC 2). The outcome is an evolving university-community partnership designed to meet changing work-force and community health needs in the heart of rural Appalachia. West Virginia University's (WVU's) application of the original Carnegie Commission AHEC recommendations (1970) resulted in the Charleston AHEC, now part of the Robert C. Byrd Health Sciences Center of WVU. AHEC today trains more than 135 residents and interns, and one-third of the third-year and fourth-year WVU medical students. Charleston offers clinical and continuing education for nurses, dentists, pharmacists, and allied health professionals. A health sciences library, distance learning, and a network of primary care clinics help define Charleston's unique AHEC role. This AHEC hub continues to meet the classic Carnegie goals of recruiting and retaining health professionals, and providing access to care in the original service area and statewide. Based on the Charleston experience, four new federally funded AHECs are being developed to link rural primary care residencies with the state-funded West Virginia rural health education partnerships. These rural consortia AHECs are applying the concept of community competency, a performance-based methodology, to integrate learning while achieving the goals of Healthy People 2010.     

Asthma: An Annotated Guide to Resources on the World Wide Web

ABSTRACT

An increasing number of children and adults are diagnosed with asthma. Current, accurate sources of information are needed to help both patients and physicians manage treatments. This article includes some background information on asthma and a list of selected Internet resources for both health care professionals as well as consumers.     

A “Medical Mission” at Home: The Needs of Rural America in Terms of Otolaryngology Care

Objectives: Describe the population, Medicaid, uninsured, and otolaryngology practice demographics for 7 representative rural Southeastern states, and propose academic‐affiliated outreach clinics as a service to help meet the specialty care needs of an underserved rural population, based on the “medical mission” model employed in international outreach clinics. Methods: A needs assessment was conducted via review of medical licensing and practice location data from state medical licensing authorities, together with population, Medicaid, and uninsured data from state health/human services departments and the US Census Bureau. Results: In all states examined, there are significantly more practicing otolaryngologists per capita in urban areas compared to rural areas (P < .05), with the exception of West Virginia, where the difference was not statistically significant (P= .33). In the majority of the states examined, there were higher rates (expressed as a percentage of total county population) of both Medicaid recipients and uninsured patients in rural counties compared to urban counties. Notable exceptions include Louisiana and West Virginia, where there are higher percentages of Medicaid patients in urban areas, and Kentucky and Tennessee, where there are higher percentages of uninsured patients in the urban areas (P < .05 for each comparison). Conclusions: Borrowing design elements from the international outreach clinics, which involve many US otolaryngologists, a similar medical mission model could be of benefit domestically. There are rural areas of the Southeast where visiting outreach clinics could improve access to otolaryngology care and facilitate effective use of existing “safety net” health care resources.     

CONSUMER NET BYTES

Abstract

The incidence of obesity has soared in recent years, as has the availability of online health information targeting this problem. This article identifies reliable Internet resources for health information about weight management for the overweight and obese. These sources have been evaluated as being useful for both consumers and health care professionals. The reviewed Web sites fall into three categories: federal government Web sites, non-profit organization Web sites, and commercial Web sites.     

Investigating the Association Between Internet Health Information Use and Patient Willingness to Communicate with Health Care Providers

ABSTRACT

Communication between health professionals and patients is an intergroup phenomenon where the health professional has the most power and status. Over the past few decades, there has been a steady increase in the availability to patients of information about healthcare and specific diseases on the Internet. In this paper, we ask whether the use of Internet health information assists patients to manage their consultations with health professionals better and whether it alters the intergroup dynamic by providing a more equal status for patients. In this study 370 participants from Australia and Canada completed a survey that included a ‘willingness to communicate with health professionals’ scale. They also commented on their use and trust of Internet health information. Thematic analysis suggests that patients’ use of Internet health information serves as a broker between patients and their health provider in health consultations. We discuss the implications of these findings for health practitioners as they address how easier Internet access influences patient interactions with health professionals. We consider future research directions these finding provide in explaining communication behaviour in this context.     

The Effects of the Internet on Pharmaceutical Consumers and Providers

The Internet has changed healthcare practice and has just begun to influence pharmaceutical consumers and providers. The Internet firstly affects the pharmaceutical consumer through the five main functions it offers to all consumers of care. These functions are: (i) to provide and distribute information; (ii) to support informed decision making; (iii) to promote health; (iv) to provide a means for information exchange and support (the community concept) and; (v) to increase self care and manage the demand for health services, thus, lowering direct medical costs. Secondly, the Internet influences the pharmaceutical consumer by enhancing the move to consumer empowerment. Thirdly, it offers increased self-care capabilities to consumers through pharmaceutical information gathering and pharmaceutical products and services purchasing using Internet pharmacies. Finally, the Internet affects the pharmaceutical consumer by enhancing efficiency in the medical management of patients.It does this by providing the means for telemedicine and telepharmacy, by changing the healthcare professional-patient relationship, and by providing a tool for registering adverse drug events. Disease management benefits include: (i) access to care for remotely located consumers; (ii) the possibility of peer consultation and of access to diagnostic and therapeutic Internet information for healthcare providers; and (iii) continuity of care via virtual community networks, integrated health systems, interconnected, real-time, virtual healthcare teams, and virtual unified electronic health records. The Internet’s effect of increasing knowledge of illicit and unregulated drugs, which may change drug use behavior and drug culture, though, makes the medical management of patients less efficient.The effects of the Internet on the pharmaceutical provider firstly relate to technological and managerial changes. The Internet, secondly, induces changes in the provision of pharmaceutical care by offering the means for telemedicine, telepharmacy, and e-commerce, for advertising, promotion, and communication with consumers, and for supporting drug safety and pharmacovigilance.The Internet’s positive influence on pharmaceutical consumers and providers, however, mainly will depend on whether proper solutions can be found for the privacy/security and confidentiality problems existing in pharmaceutical information gathering and pharmaceutical products and services purchasing. Special focus should be placed on ensuring the privacy of consumer information and on the secure transmission of financial information. The best defenses will be adequate, national, international, and global laws and regulations which ensure privacy/security and confidentiality on a global level.