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Euro'vision blog

A look at the key issues for pharma across Europe

Online disease management – white knight or white elephant?

Online disease management and compliance tools are proliferating at a steady rate on the web. Everyone is investing heavily – but where is it all getting us, or indeed the online users?

We all hope that access to online disease management and compliance tools will improve the quality of healthcare and also increase adherence and persistency rates. But the truth is – we don't really know if what we are providing is either particularly useful and/or is having an impact on the treatment of patients.

So it's interesting to look at a recent article in the February issue of the JAMIA (a journal of informatics in health and biomedicine published by the BMJ at jamia.bmj.com). These are the results of a study that has attempted to review and assess web-accessible tools for the management of diabetes and related CV risk factors.

The researchers looked at 92 web-based tools and 57 studies associated with them to make their assessment. And a rough summary of the findings makes interesting reading. They found that most of the tools studied were either not simple enough, had problems with usability, and didn't provide enough interactivity or feedback. Not surprisingly most experienced “high attrition rates”.

Given the hopes everyone has and investments being made in these types of tools, this makes somewhat disturbing reading. Even more worrying is the clear lack of any standards by which physicians and patients can assess the tools, and perhaps worse the lack of a virtuous circle of feedback from the tools currently available. The standard metrics used to assess online use and usability may not be sufficient to give a real insight into what works and what does not.  

I think the final conclusion from the paper succinctly sums up the situation. It reads: “Web-based tools have the potential to improve health outcomes and complement healthcare delivery, but their full potential is hindered by limited knowledge about their effectiveness, high prevalence of usability errors, and high attrition rates. A development and research agenda should include: developing strategies to reduce website attrition in order to maximise clinical outcomes; standardising website quality indicators; and transparent reporting of these indicators in order to allow patients and clinicians to make informed decisions about website choice.”

Of course this begs the question – who is going to set up these standards and quality indicators, and who will coordinate the reporting of them? Perhaps this is the time for the key stakeholders in this area to get together and agree a way forward, perhaps setting up an independent standards' group. Certainly given the time taken for legislation on information to patients at the European Parliament level to work its way through the Commission and the Parliament (and legislation is still not agreed) we cannot wait for the European Authorities to see the issue and act, and the clock for hundreds of thousands of patients is ticking…

Article by
Max Jackson

Max Jackson is CEO, EMEA & APAC, Sudler & Hennessey and former chair EACA Healthcare Communications Council

28th February 2012

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