This week in the BMJ
Volume 328, Number 7449, Issue of 15 May 2004Online communication improves the quality of health care
Online communication improves the quality of health care
Web based chronic care programmes may shift the focus of attention on to patients' daily needs and make them feel more secure and supported. Ralston and colleagues (p 1159) interviewed nine patients taking part in "living with diabetes," a web based disease management programme to support the care of patients with type 2 diabetes. They found that participants were more secure about their health and health care, and felt they were looked after more closely by their healthcare providers. When the programme did not work as expected, however, patients felt more isolated, and unmet expectations attenuated the positive impact of the programme. Web based support promotes a collaborative relationship between patients and healthcare providers, say the authors, but it is important to be open about what the programme can and cannot deliver.
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Handheld computers may improve patients' care
Doctors believe handheld computers will improve patients' safety and quality of care, and that they will be regularly used in the future. Scheck and colleagues (p 1162) interviewed 54 doctors who did or did not use handheld computers, and found that their use varied widely in clinical practice. Those who used handheld computers felt that they could make safer decisions and improve productivity and interactions with patients. Physical constraints, unfamiliarity with modern technology, and personal preferences prevented their use by some. Doctors were also concerned with the security of patients' information, over-reliance on technology, and the reliability of devices. Training and support from the doctors' institutions could improve acceptance of handheld computers and be advantageous for both institutions and doctors.
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Do virtual communities help patients?
The effect of online support groups on health and use of healthcare resources remains unclear. Reviewing 45 publications focusing on virtual communities, Eysenbach and colleagues (p 1166) found that only six focused on peer to peer interventions, and most of the studies were of poor quality. There was no clear evidence of improvement of depression scores, healthcare use, and social support measures by participating in virtual communities, but there was also no evidence of negative or harmful effects. The absence of evidence does not mean that virtual communities have no effect, say the authors, but we need more evidence to assess if they can replace or complement face to face support groups.
Computers do not prevent all inappropriate prescriptions
Computing systems used in general practice may fail to warn of drug interactions and hazardous drug combinations. Using 18 simulated cases, Fernando and colleagues (p 1171) tested the safety of the four computing systems used by three quarters of general practices in the United Kingdom. They found that all systems may fail to warn of potentially dangerous prescribing errors, putting patients at risk. However, computers reduce errors by up to 60% simply by making prescriptions legible, says Ferner (p 1172) in a commentary. Better education on drug use is paramount, and timely and relevant warnings would prevent disasters and act as a safety net.
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Soft networks close the gap between research and practice
An informal email network may improve the knowledge for evidence based health care and encourage communication between specialties. Analysing the activity of CHAIN (Contact, Help, Advice and Information Network for Effective Health Care, an informal email network for people working in health care), Russell and colleagues (p 1174) found that members were able to improve cross-professional contact and share innovation, good practice, and research ideas. Soft networking enables knowledge for evidence based health care to be personalised and made meaningful through informal social interaction, say the authors, and skilled staff can encourage a strong culture of support and reciprocity.
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