For the growing number of Americans living with chronic health conditions, such as diabetes , just having access to one’s doctor during scheduled office visits isn’t always enough. If a question arises or if a patient wants feedback on the progress they’re making between visits, it often means waiting until another appointment.

It used to be that this communication gap was easily filled with a phone call or two—something not as realistic in today’s society. Enter the Internet. With an estimated 100 million Americans currently using email, Internet technology has become mainstream. The Internet offers an efficient way of increasing communication between patients and their healthcare providers, which could improve quality of care and patient satisfaction. And according to one survey, half of all Internet users would like to communicate with their doctor online.

Using the Internet for chronic disease management provides an opportunity to extend the continuum of care, adding focus to day-to-day disease management. But this is still a new area, and not much is known about the impact of using the Internet as part of clinical care. A new study in the May 15, 2004 issue of the British Medical Journal describes the experiences of people with type 2 diabetes enrolled in an Internet-based disease management program.

About the Study

This study included nine adults between the ages of 45 and 60 who were all part of a pilot Internet-based diabetes management program for people with type 2 diabetes. This program provided participants access to their electronic medical records, secure email, the ability to upload blood glucose readings, a diabetes education website, and an interactive online diary for entering exercise, diet, and medication.

Doctors responded to email messages during weekdays, and reviewed uploaded glucose levels at least once a week. The researchers interviewed the participants before and after the program to find out about their expectations and subsequent experiences.

The Findings

The initial interviews showed that participants were often reluctant to seek face-to-face care from their providers unless they felt sick or perceived some other urgent need to do so. But with the Internet-based support program participants felt:

  • Their relatively minor, non-urgent concerns mattered to their doctors
  • They were better able to manage their diabetes
  • An enhanced sense of security about health and health care

At the same time, however, participants also felt that the program did not completely meet all their expectations, and some found it difficult to fit into their daily lives.

A limitation of this study is that it consisted of a rather small group of people who may not be representative of the general population. Additionally, 20 of the patients initially approached about being in this study declined—had they participated they may have had different experiences with program than those who participated.

How Does This Affect You?

This study suggests that the Internet offers a viable means of increasing communication between patients and their providers. Giving patients access to their providers via email provides them with an opportunity to express any concerns and receive feedback on an as needed basis between visits. This can alleviate a lot of unnecessary anxiety, and may alert doctors to situations where a patient should be advised to come into the clinic. Certain program components—such as diet and exercise logs—may also motivate patients to become more involved with managing their condition.

But for this type of program to work, there are some assumptions. First, it assumes that patients with chronic diseases are computer literate, which may not be true for this generally older population that did not grow up with personal computers. Second, it assumes that these patients have high-speed access to the Internet. Patients are less likely to take full advantage of the service if they are constantly frustrated by slow dial-up connections. A final assumption is that providers have the time and support necessary to track and respond their patients’ data and queries. While many physicians would view this as an added burden, caring for patients online is arguably far more efficient than trying to return their calls or seeing them in the office for minor concerns.

While many patients in this study were frustrated that the program did not meet all of their expectations, it’s important to be realistic about what this type of program can and can’t do, and realize that it’s meant to be a supplement not a substitution for traditional care.

Electronic communication has the potential to provide patients with more convenient access to both their providers and healthcare information. This is especially useful for effectively managing chronic conditions, such as diabetes, where a patient can clearly benefit from more continuous care, but doesn’t require daily visits to their doctor.