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The internet and healthcare information

David J Woods
MPharm MRPharmS
Drug Information Consultant
Senior Teaching Fellow
School of Pharmacy
University of Otago, Dunedin
New Zealand

The availability of information on the internet has made a significant impact on the practice of pharmacy and medicine over the last 10 years or so. Until recently, specialist units almost exclusively provided drug information services. These units had to subscribe to high-cost bibliographic databases and hard-copy medical journals, which were often difficult to access by the day-to-day practitioner. The internet now plays an important part in medical and pharmacy practice, but well-conducted research is required to clarify and quantify the value and possible pitfalls of the information explosion.

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Information access
Access to drug and medical information is now rapid and cheap. The list of quality information gateways and link sites is constantly expanding. These sites can provide the resources to deal with many day-to-day clinical queries. There is also an increasing range of full-text journals available on the internet. Many of these provide free email notifications of content and can be customised to provide items of personal interest. Table 1 lists some website categories with examples.


Peer support and opinion
The use of email listservs and discussion groups has revolutionised information exchange in recent years. Most practitioners are members of at least one discussion group in a subject area relevant to their practice. There are interesting psychosocial elements in the operation of a discussion group. Most groups require a critical mass of regular contributors to be fully interactive. When this stage is reached the interaction can provide a powerful learning experience for the majority of “silent” subscribers. The use of an active group can assist in identifying and resolving challenging problems within hours of posting messages. Internet and email addresses are now frequently included on research papers so it is much easier to contact the authors to ask for further details or advice.

Unregulated information
The internet is not regulated and consequently information on it is of variable quality, accuracy and currency.  There is a large volume of factually incorrect and out-of-date information that even the most efficient surfers will come across. This causes considerable information noise when the evidence-based facts are required.  Practitioners now need to be skilled in filtering and appraising information in order to provide factual advice to often confused consumers (patients and other health professionals).

There are obvious disadvantages to the plethora of unregulated information on the internet. However, unregulated information represents the voice of free speech, and regulation would pose the considerable challenge of deciding where to draw the line between “good” and “bad” information. As regulation is virtually impractical, the focus should be on educating health professionals and patients on how to appraise information in order to facilitate accurate decision-making. This skill is increasingly important as patients present with the results of their own extensive searches.

Information overload
Good information management skills are required to deal with the sheer volume of information that can be accessed or sent via email. Without initial instruction most practitioners will pass through phases as they develop their skills in the use of the internet (see Table 2). Most of you will relate to this experiential learning process, and the move to phase 3 (rationalisation) requires practice, effort and perhaps formal instruction. All practitioners who are directly involved in the provision of information should aspire to attain phase 3. Surprisingly few practitioners use electronic databases to store and retrieve their information. Against the backdrop of the internet revolution, paper records are still predominant, especially for individual practitioners.


Direct-to-consumer (DTC) advertising
Drug advertisements on TV and in popular magazines are now permissible in some countries. The arguments for and against this are well balanced: for example, consumer rights versus the commercial motives of drug companies. Due to the unregulated nature of the internet, the argument against DTC loses some validity as drug advertisements and marketing techniques are widespread on the internet. All new drugs have dedicated websites and are often found easily by typing in the relevant disease into a search engine.

Information access for developing countries
Several initiatives have improved the flow of information to and from developing countries. An increasing number of full-text journals are available on the ­internet, and connection speeds are improving all the time, even in remote situations. Education and training in the use and application of the information presents a growing need, and the use of the internet to deliver such training is a logical progression.

Information sharing
This occurs via discussion groups and mailing lists, but the potential for efficient sharing of information is largely unrealised. For example, several countries now have drug information networks, but few of these regularly collate and distribute peer-reviewed responses to drug information questions. Every day in each country, throughout Europe and the world, the same questions are being asked. In many cases these questions have been researched at length and answered by another centre. The opportunity exists to share this information more efficiently via shared, peer-reviewed, web-based databases.

Dynamic databases
The time lag between editions of a drug information textbook can present a significant information vacuum. CD-ROM databases with companion websites for updates or constantly updated web-based versions are increasingly available. There is still a lot of scope for development in this area.

Education and training
The science and practice of web-based learning is new but expanding rapidly. The ability to engage participants from distant sites in a flexible learning environment is very attractive. Web-based learning presents an ideal medium for teaching practitioners the skills required to deal with many of the issues raised in this article.

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