Internet and Patient Education: the current evidence for chronic disease management

Persephone Doupi, Pekka Ruotsalainen
Centre of Excellence for Information and Communication Technologies, STAKES, Finland

Objective: The Internet has been acknowledged and established as a powerful channel for the distribution and communication of health-related information, therefore raising the interest for its adoption in patient education strategies. We undertook a systematic review of the literature in order to identify evidence of the effectiveness of Internet use in patient education programs, targeting specifically clinical domains with a chronic course (such as diabetes, asthma, cardiovascular diseases, dermatological conditions, etc.). Particular emphasis was placed on the technological features of the applications involved and on the considerations undertaken in the process of their design and implementation, as critical success factors for these interventions.

Methods: Data sources : We devised a search strategy on the basis of MeSH subject headings, to broadly cover the areas of patient/health education, patient and consumer participation, disease management and Internet applications. We initially used this strategy to search MEDLINE, as a primary health literature resource.

Study Selection Criteria : In order to be considered for review, identified publications should: address patient education interventions aimed at a chronic disease or condition; target any age group of patients and/or their carers or family members; involve the use of Internet-enabled applications ; report on a randomized controlled trial, controlled clinical trial or clinical trial or be validation or evaluation studies or meta-analysis. Publications addressing acute or temporary medical conditions, dental care, general health promotion or preventive interventions targeted at healthy individuals were excluded. Additionally, we excluded interventions targeted exclusively at health care professionals, as well as opinion or viewpoint papers, commentaries and publications discussing methodological issues of patient education.

Results: Our search of MEDLINE (1966 - 2003) retrieved an initial set of 3443 items in total. Limiting the results only to items with an abstract and to publications concerning human subjects reduced the set to 2408 items. Selecting only items with the publication types listed in the inclusion criteria resulted in a set of 264 articles. We are currently processing this subset, extracting information on the following areas: a) general information (year of publication, country, type of study, clinical application domain); b)information regarding the patient education intervention (based on a previously proposed taxonomy for patient education research reporting and on research in the field of chronic conditions management); c) information regarding the IT tools and infrastructure used in the intervention. Further study selection is in progress, through adaptation and use of the search strategy across additional relevant resources, such as CINAHL, INAHTA-HTA, the Cochrane Collaboration database etc.

Conclusion: The application of the Internet in patient education is still a largely unexplored research area. The systematic literature review we have undertaken aims at providing an overview of the currently available evidence regarding the effectiveness of Internet-enabled patient education strategies, particularly in the context of chronic disease management. An analysis of the findings that correlates effectiveness with specific system characteristics, as well as with the features of the clinical application domain can provide valuable input for the design and development of patient education systems, as well as for the successful incorporation of the Internet in patient education programs.