APPROPRIATE USE OF THE INTERNET

Sandra R. Bai, PharmD, RPh

PGY1 Regulatory Pharmaceutical Fellow in Drug Information
Purdue University | Janssen Scientific Affairs, LLC | FDA
August 31,2016

Objectives
1.

Summarize use of online health information by

the public

2.

Explain proper and improper use of online

health information to patients

3.

Identify reliable sites containing useful health

information and refer patients to them

4.

Cite online health information appropriately

Online Health Information

72% of internet users say
they looked online for
health information within
the past year
93% search for a particular
illness or condition
64% look for information
about prescription drugs
48% look for information
about alternative or
experimental treatments or
medicines

Fox S, Rainie L. Vital decisions: How internet users decide what information to trust when they or their loved ones are sick 2002; Washington, DC, Pew Internet & American Life Project.

Online Health Information

72% of health seekers say you can believe all
or most of the health information online
69% say they have not seen any wrong or
misleading health info on the Web
28% say they have seen bad information

Fox S, Rainie L. Vital decisions: How internet users decide what information to trust when they or their loved ones are sick 2002; Washington, DC, Pew Internet & American Life Project.

How Should HCPs Respond to

Patients Questions?
27% of health seekers spoke to a doctor or
other HCP about the information found
during their most recent episode of online
searching
79% of those who talked to an expert, said their HCP
was interested in the information found online
13% reported the health care professional was not
too interested or not at all interested

Importance
Consequences of unreliable health information online:
Spread of inaccurate information to family, friends,
colleagues
Decreased value of HCP recommendations
Disease exacerbation
Adverse reactions
Reliable information online
Where to find it?
How to evaluate it?
How to reference it?

Health Communication and Health

Information Technology
Healthy People 2020
Goals
Improve outcomes and quality

of care for patients

Achieve health

equity
Increase use and access to health technology
Increase health literacy

Facilitate the meaningful use of health IT and exchange

of health information among health care and public
health professionals.
Department of Health and Human Services. Health Communication and Health Information Technology. Healthy People 2020 Topics and Objectives. Available at:
http://www.healthypeople.gov/2020/topicsobjectives2020/default.aspx. Accessed August 17, 2015.

Impact of Online Health Information

for Patients
Patient education and empowerment
Hypochondriasis/Cyberchondria
Pre-occupation with the fear of having or developing a
serious disease
Negatively affects quality of life
Higher medical care utilization

Muse K, McManus F, Leung C, et al. J Anxiety Disord 2012:189-196.

Pharmacists & Online Health Information

Patient

Pharmacist

Internet

Uses of Online Health Information

i>Clicker Question
Which of the following is the least credible source of information
about alternative medicines?
a.
b.
c.
d.

National Center for Complementary and Alternative Medicines

Dietary Supplements: Medline Plus
Ask A Patient
NIH Office of Dietary Supplements

General Access
General search engines
http://www.google.com/
http://www.yahoo.com/
Meta-search engines
http://www.dogpile.com/
http://www.metacrawler.com/
Specific web-address
http://www.fda.gov/

Wikipedia
NEVER REFERENCE
Wikipedia compared to Medscape Drug Reference
Scope, accuracy, and completeness
Less information, no dosing, less complete answers on Wikipedia

Drug Safety
New FDA safety communications were not updated in a timely manner
(i.e. black-box warning)
After communication, 82% increase in Google searches and 175%
increase in Wikipedia page views

Clauson K et al. Ann of Pharmacother 2008; 42: 1814-21

Hwang TJ, et al. N Engl J Med 2014; 370: 2460-2.

Wikipedia
PROS

CONS

Accessible
Consumer friendly

Anyone can update

May contain
inaccurate/inappropriat
e information
Years until article is
complete

Government Sites
FDA http://www.fda.gov/
Orange Book, Drugs@FDA, etc.
CDC http://www.cdc.gov/
NGC http://www.guideline.gov/
NIH http://www.nih.gov/
NLM http://nlm.nih.gov/

Disease State Specific Sites

AIDS http://www.aids.gov/
Juvenile Diabetes Research
Foundation http://www.jdrf.org/
American Academy of Allergy Asthma
& Immunology http://aaaai.org/

American Lung Association

http://www.lung.org/
National Osteoporosis Foundation
http://www.nof.org/

General Health Care

My OptumHealth http://www.myoptumhealth.com/portal/
Health on the Net Foundation
http://www.hon.ch/MedHunt/
National Library of Medicine (NLM) MedlinePlus
http://www.nlm.nih.gov/medlineplus/

Health Information for Patients

Alternative Medicine

http://www.nccam.nih.gov/

http://ods.od.nih.gov/

http://www.quackwatch.com/

Pharmacy Profession

American Society of Health-System Pharmacists (ASHP)

American Pharmacists Association (APhA)
American Association of Colleges of Pharmacy (AACP)
National Pharmaceutical Association (NPhA)
National Community Pharmacists Association (NCPA)
National Association of Boards of Pharmacy (NABP)

To Recommend or Not To
Recommend?

EVALUATE THE SITE

https://www.google.com/#q=viagra+and+hearing+loss

1. Who runs the website?

2. What is the purpose of the

website?

3. What is the original source of the

information on the website?

4. How is the information reviewed

before it is posted on the website?

5. How current is the information on

the website?

Finding the Most Credible Sources

Health on the Net (HON) Foundation
http://www.hon.ch/
Code of conduct
Formal registration by website required

HONcode Certification
1.
2.
3.
4.
5.
6.
7.
8.

Authoritativeness Authors qualifications

Complementarity Information that complements the
patient-provider relationship
Confidentiality Privacy and confidentiality
Attribution Citations and dates
Justifiability Ability to support claims of
benefits/performance
Transparency Valid and accessible contact
information
Financial Disclosure Details of funding
Sponsorship Distinguishes advertising from editorial
content

Boyer, C. Health On the Net Foundation. When the quality of health information matters: Health on the Net is the Quality Standard for Information You Can Trust. Available at:
http://www.hon.ch/Global/pdf/TrustworthyOct2006.pdf. Accessed August 18, 2015.

HONcode Certification

HON stamp of approval

Evaluating Websites
http://www.fda.gov/Drugs/DrugSafety/Postm
arketDrugSafetyInformationforPatientsandPro
viders/ucm124841.htm

1. Who runs the website?

2. What is the purpose of the

website?

3. What is the original source of the

information on the website?

4. How is the information reviewed

before it is posted on the website?

5. How current is the information on

the website?

HON Stamp of Approval

Proper Referencing

Website

Database

Authors (if indicated). Organization responsible for the site. Title of page or document.
Available at URL. Accessed Month day, year.
Example:
Food and Drug Administration. MedWatch: The FDA Safety Information and Adverse
Event Reporting Program. Available at:
http://www.fda.gov/Safety/MedWatch/default.htm. Accessed August 30, 2011.

Authors (if applicable). Name of monograph or document. Database name. Company (or
vendor) maintaining the database. City, State Abbreviation. Available at: URL. Accessed
Month day, year.
Example:
Grapefruit/Atorvastatin. Herbal Interaction Facts. Online Factsandcomparisons. Wolters
Kluwer Health, Inc. Conshohocken, PA. Available at:
http://www.online.factsandcomparisons.com. Accessed August 30, 2011.

AMA Citation Guide Summary

Purdue Reference Guide

APPROPRIATE USE OF THE INTERNET

Sandra R. Bai, PharmD, RPh

PGY1 Regulatory Pharmaceutical Fellow in Drug Information
Purdue University | Janssen Scientific Affairs, LLC | FDA
August 31,2016