A website to improve asthma care by suggesting patient questions for physicians: qualitative analysis of user experiences

Article Review

Hartmann CW, Sciamanna CN, Blanch DC, Mui S, Lawless H, Manocchia M, Rosen RK, Pietropaoli A. A website to improve asthma care by suggesting patient questions for physicians: qualitative analysis of user experiences. J Med Internet Res 2007; 9:e3

Question

What experiences do patients with asthma have when using a website providing tailored recommendations on questions to ask physicians before visits?

Methods

Design

Qualitative study

Setting

Patients in the community associated with a large health insurance company in Rhode Island.

Patients

37 patients, 21 years old and older, with self-reported history of asthma and a planned visit with a primary care physician in the next two months, and internet access. Patients were recruited through mailings and a Google advertisement.

Intervention

Access to a web site that asked 10-20 assessment questions about their asthma and its care, then provided (1) feedback on questions to ask the doctor at the next visit and (2) links to information sources. Patients were contacted by e-mail prior to doctor visits, and were telephoned if they did not use the system by 72 hours prior to the appointment.

Data collection

Semi-structured interviews by telephone.

Analysis

Interviews were transcribed and coded using grounded theory techniques.

Main Results

Patients had several specific suggestions for improving the website (such as providing more detail and more novel information). Two main themes emerged. First, patients felt more self-confident in initiating conversations and communicating with the physician at the subsequent clinic visit. Second, patients were more engaged in their care plan outside of the clinic visit. No patient had a negative experience with the physician as a result of exposure to the website, and patients saw the website as reinforcing rather than undermining the advice they received from their physicians. In a secondary analysis, a random national sample of 26 primary care physicians reviewed the site and a large majority rated it positvely.

Conclusion

In these patients, the asthma website had its intended effect of improving patient engagement, a key element of the Chronic Care Model. It is notable that the intervention was intended to improve self-care by improving the quality of the patient-doctor encounter, using active prompts to promote patient use of the website before visits. My own experience is that eHealth programs for chronic disease management that are closely linked to the clinic visit may be more effective than programs with absent or weak links to the visit.

Several questions remain. First, when this website is offered outside of a research study, will the results be similar? The patients who volunteered for the study are likely to be substantially different (likely more interested and engaged) from other asthma patients who could benefit from better management. I suspect patients will still need considerable prompting to use the system, but I am also reasonably confident that those who actually use the system will find it valuable. Second, will the beneficial outcomes persist at subsequent visits, or will the effect diminish as the novelty fades?

Although these questions are unresolved, and the study was not intended to assess actual clinical outcomes, it is a promising demonstration of the potential for eHealth interventions that activate patients before clinic visits to improve chronic disease management.

Stephen E. Ross MD

University of Colorado - Denver School of Medicine

Aurora, Colorado