As far back as 1998, the Swedish non-commercial public health service Infomedica opened an ‘Ask the Doctor’ service on its internet portal. This was to establish reasons for consulting a doctor on the internet.
Between November 1, 2001 and January 31, 2002, all inquirers at Infomedica's Ask the Doctor service were invited to take part in a survey. During the period of the survey a total of 3622 inquirers, 1036 men (29%) and 2586 (71%) women, used the service.
Respondents were asked to select multiple-choice and free text options. More than one fourth (360 participants), chose to use the free-text box. A wish for a second opinion was the most common reason among the answers, expressed by more than one fifth of the participants.
The results of the (free-text) reasons for using the Doctor service were as follows: (1)
· Second opinion (in 110 of 360 free-text answers, 31%)
· Discontent with previous doctors (89/360, 25%)
· Primary evaluation of a medical problem (53/360, 15%)
· Convenience, distance, and time (49/360, 14%)
· Embarrassing concerns and worries (16/360, 4%)
· Preference for written communication (15/360, 4%)
Back then, the increase in the use of computers had already made the internet more accessible and it is therefore easy to understand why convenience was a major reason for participants choosing internet consultations.
There aren’t any comparable surveys and very few sites offering internet doctor services in developing countries like South Africa, however in February 2013, the Digital Media and Marketing Association (DMMA) released findings from a survey conducted on South Africa’s internet-using population.
It’s no surprise that growth is an upward trend. Internet use in South Africa grew by over 2 million from the previous twelve months, hitting the 14 million mark. The majority of internet users (95%) indicated that they used the internet for email, followed by web browsing (84%) and social networking (78%). (2)
According to the survey results, the main drivers for internet users’ growth was the decline of the cost of mobile data and the growth of smart phones and other advanced mobile devices.
The study also contradicted the popular perception that the internet is predominantly used by the youth. “Eleven percent of today’s internet users are 50 years or older, with 60% of users between 25 and 49 years old, “ said the authors. “The latter sample is also an educated one: 13% have university degrees and, while this is not the majority, it is indicative of an educated internet population.”
The DMMA study also found that 34% of South African consumers access the internet from work and 52% of respondents reported shopping online. The online shopping findings are promising for e-commerce as South Africans are known for their reservations in adopting to this retail channel which is well-established in many developed countries.
And if this trend is starting to grow, it is likely that the use of the internet as a source of health information and services could or already be following that of developed countries.
According to the Health Online 2013 Survey by Susannah Fox and Maeve Duggan study which looked at browsing behaviour and not at internet doctor consulting services , “One in three American adults have gone online to figure out a medical condition. Thirty-five percent of U.S. adults say that at one time or another they have gone online specifically to try to figure out what medical condition they or someone else might have.”
These findings come from a national survey by the Pew Research Centre’s Internet & American Life Project. (3) 46% of online respondents found information online led them to think that they needed the attention of a medical professional but did not necessarily indicate that they received advice over the internet.
Berland et al. as far back as 2001 noted that patients using the web for medical information may be “negatively influenced” and have difficulty finding complete and accurate information online (4)
This highlights an important issue. What is the best way for healthcare professionals to assist internet users where they are vulnerable to disinformation and varied interpretation?
Telephonic consultations are routine in many general practices but they are predominantly localised and often do not span the vast geographic range of the internet. Some NHS doctors in the United Kingdom (UK) offer email contact with patients interspersed with face-to-face consultations.
The website http://www.doctorfox.co.uk is an online doctor and pharmacy service in the UK which offers an unlimited email contact service with a doctor.
In a British Medical Journal (BMJ) article, Tony Steele who set up Dr Fox said that many routine face-to-face consultations with GPs could be done safely online. Dr Steele, who is a general practitioner, also stressed that he is aware that his service doesn't have access to notes on medical history. "We are more conservative than any other clinic we know." (5)
When it comes to health monitoring devices, these have traditionally been developed by medical technology companies and used in health care facilities to diagnose, monitor and manage a myriad of medical conditions. However, the launch of personal health and fitness monitoring devices along with apps has spawned a whole new industry.
In an integrative review on smart phones for long-term health management, smart phone interventions offer promising solutions for long-term health management due to the rapidly growing number of patients with chronic diseases.
A study in China found that management of some chronic diseases could be at least partially effective through smart phone intervention. (6)
The results of the study found that with the help of health-related smart phone apps, patients with chronic conditions felt secure in the knowledge that their illnesses were closely monitored. They also felt that they participated in their own health management more effectively and that they had not been forgotten by their doctors and were taken good care of even outside the hospital/clinic. However the study also found that there was a need for more smart phone apps to be developed to help people manage chronic diseases.
This is all indicative of an appetite for self health management combined with health care supervision using technology. Taking on this challenge, technology company Apple are redefining healthcare through ‘wearables’ which will not only monitor, but diagnose health problems signalling the next leap in the virtual healthcare technology revolution. (7)
Apple recently announcement the launch of their app called "Health". Apple saw an opportunity to not only introduce a gadget to track vitals but has created an infrastructure to connect them together and for doctors to monitor data collected on these gadgets providing real-time diagnosis/treatment.
This tracking system will have a common, single interface to connect all wearable devices, enabling it to provide this data with various levels of built-in privacy for doctors and nurses who in turn can monitor every action and habit.
An app such as the Health App can automatically detect signs and alert a nearby ambulance service or assigned health care professional.
So is this a virtual health care revolution?
In the US, more states require insurers to cover health care by internet or phone. Twenty states in the District of Columbia have passed parity laws requiring some private health insurance companies to cover telemedicine services. (7) This means that not only do the patients benefit from the service, health care practitioners are being compensated for their time accordingly.
In South Africa there is a chronic shortage of health care professionals, an overburdened public healthcare system and a growing trend towards the use of internet services. Many health care practitioners including the allied professions could use their time more efficiently and cover greater geographic areas if they were in touch with patients via the internet.
Health care providers should recognize that patients are probably using the World Wide Web as a source of medical and health information. They can assist patients who are already using this resource by suggesting web-based health services and participating in live chat platforms which connect health and wellness experts with their patients and people seeking advice in real-time. This way the knowledge gap outcomes can also be managed effectively as the virtual health care revolution leaps forward.
1. Umefjord G, Petersson G, Hamberg K; Reasons for Consulting a Doctor on the Internet: Web Survey of Users of an Ask the Doctor Service; J Med Internet Res 2003; 5(4):e26; URL: http://www.jmir.org/2003/4/e26/
2. DMMA survey reveals state of SA’s online nation; Wednesday, February 6th, 2013 at 9:42 am.; URL: http://www.iabsa.net/news/dmma-survey-reveals-state-of-sas-online-nation/
3. Pew Research Internet Project; URL: http://www.pewinternet.org/2013/01/15/health-online-2013/
4. Berland GK, Elliott MN, Morales LS, et al; Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285:2612–21
6. Jingting Wang, Yuanyuan Wang, Chunlan Wei, Nengliang Aaron Yao, Avery Yuan, Yuying Shan,Changrong Yuan; Smartphone Interventions for Long-Term Health Management of Chronic Diseases: An Integrative Review; Telemed J E Health 2014 Jun 1;20(6):570-83. Epub 2014 May 1; URL: http://www.ncbi.nlm.nih.gov/pubmed/24787747
7. Health. An entirely new way to use your health and fitness information; URL: https://apple.com/ios8/health/
8. Jonnelle Marte, Market Watch; More states require insurers to cover health care by phone or internet: URL: http://www.marketwatch.com/story/the-doctor-will-facetime-you-now-2014-03-03
5. McCartney M; The doctor won’t see you now: online consulting and prescribing; BMJ 2012;345:e7238; URL: http://dx.doi.org/10.1136/bmj.e7238; 30 October 2012