Rx isn't just medication anymore

Washington -- Officially directing patients to a reputable Web site to research a disease or condition is an idea whose time has come, according to physicians who have participated in pilot projects for Prescriptions for Information.

The program, a joint effort of the National Library of Medicine and the American College of Physicians Foundation, encourages physicians to write prescriptions for a trustworthy, commercial-free Web site packed full of free information -- the NLM's MedlinePlus.

Patients with chronic diseases such as diabetes and heart disease constitute a large part of primary care physicians' practices, and doctors believe that educating them on the management of their disease is about as important for effective treatment as is medication. But ever-briefer office visits leave no time for this exercise.

Physicians say patients have responded positively to the new program and that it encourages them to become part of the treatment team.

When Jacqueline W. Fincher, MD, an internist in Thomson, Ga., who has participated in the program, hands patients a signed prescription directing them to research their disease or condition on MedlinePlus, she tells them, only half joking, "Here's your homework. When you come back we'll have a quiz. I want to know what you've learned."

She recently told a patient with lupus: "At the end of six months, you need to know more about this disease than I do, because you're going to live with it for the rest of your life."

A web-savvy generation

The NLM launched the program with the ACP Foundation because of the belief that a better treatment outcome is more likely if a patient understands the problem and the doctor's recommendation, said NLM Director Donald A.B. Lindberg, MD.

Many patients, including those 65 and older, are likely to turn to the Internet for their health information anyway, so all the better to guide them to reputable sources. A recent study by the Pew Research Center found that 22% of seniors already use the Internet, and the thought is that the numbers are likely to increase as computer-savvy boomers attain senior status.

Dr. Lindberg is also pleased that more people will become familiar with the library Web site with its information on 650 diseases and conditions and links to the latest professional articles on health topics. It also features graphics for patients with reading difficulties.

There are about a million searches a day on MedlinePlus, but many more people could benefit from it, Dr. Lindberg said.

So far, the program has been tested by more than 500 internists and their patients and stands ready to be adopted by many other specialties. Oncologists were particularly interested in the program, said Sarah Corley, MD, an internist in Springfield, Va., who is also involved in the pilot.

Launched nationally on April 22, the opening day of the ACP annual meeting in New Orleans, the program provides participating physicians with a poster, bookmarks and a supply of prescription pads on which they can write in a disease or condition and advise patients how to look up the information.

The prescription pad is an important part of the program, elevating information to the same status as medication, Dr. Fincher said. It also serves as a reminder to patients who are often nervous or anxious in the physician's office and fail to register just what is being said, Dr. Corley added.

Surveys conducted by the NLM also revealed that patients prefer to receive information from physicians and nurses and often sought their guidance on where to look on the Internet for reliable information, Dr. Lindberg said.

Directing patients to a reputable site also cuts down on the visits they pay to less-than-reputable ones. Many of the printouts Dr. Fincher would review with patients began with the word "natural," she said. "I would tell them that cyanide is natural, but it's a poison. Natural doesn't necessarily mean healthy." She doesn't see as many of those printouts anymore.