Patient Education Level and Utilization of Internet Resources by Patients in Orthopedic Hip and Knee Consultations

Introduction: Internet has become an increasingly popular source of reference for patients to learn about their medical problems. It is easily accessible, and a large number of uncensored information is available online written from various sources and perspectives. However, the role of internet and its impact on patient’s care and understanding of the disease remains unclear. The purpose of this study is to evaluate the role and effect of internet use for patients seeking consultation for hip and knee arthritis. More specifically, the relationship between patient’s education level, internet use, motives for doing background readings, perception of internet information, and reactions to the available information will be studied. Method: Patients seeking orthopaedic consultation for knee or hip arthritis at the Toronto Western Hospital were identified and invited to fill out a questionnaire on their first visit. The questionnaire was designed to assess the patients’ pre-consultation reading habits, their use of internet, and their reaction to what they have read on the internet. The questionnaire also included questions about the respondent’s background.Results: In comparing patients holding college/university degree (CU) with patients having no college/university education (NoCU), the CU group were associated with increased internet use (CU vs. NoCU: 71.0% vs. 48.3%;p 0.01) and background reading (CU vs. NoCU: 82.2% vs. 17.8%;p 0.001) prior to consultation;fewer incidence of anxiety following internet use (CU vs. NoCU: 29.9% vs. 53.6%;p 0.05);and higher rates of decisions influenced by internet use (CU vs. NoCU: 20.8% vs. 3.6%, p 0.05). Internet users demonstrated a higher confidence in gathering and understanding medical information (Internet users vs. non-internet users: 6.59 ± 2.05 vs. 5.03 ± 2.78;p 0.001) and rated the accuracy of information on internet at 7.18 ± 2.01 (max = 10). Conclusion: Internet use can influence patient’s treatment decision, anxiety level, and understanding of their disease. Caregivers must recognize the growing trend of internet use and should counsel and educate their patients appropriately based on what they have read to help them accurately appreciate the nature of their disease.

Factors Determining Wait-Time and Patient Satisfaction at Post-Operative Orthopaedic Follow-Up

Introduction: There has been increasing attention on the evaluation of the efficiency and delivery of healthcare while trying to maintain the quality of service patients expect. A variety of studies have looked at various, non-orthopaedic surgical outpatient clinics and the factors involved in patient satisfaction and wait-time. The purpose of this study was to identify if such a relationship exist between the environmental, patient, and social-demographic factors to patient wait-time and satisfaction at an orthopaedic follow-up clinic. Methods: Patients were tracked through the clinic at various time points: appointment time, registration time, time to diagnostic imaging, time to being called into an exam room, time to being seen by a trainee, time to being seen by the staff surgeon, and time of leaving the clinic were collected. Overall satisfaction scores were calculated as per the VSQ-9. Patients who presented for their two or six week follow-up appointment were compared to those presenting for their three, six, or 12 month follow-up appointment. Result: A total of 80 patients were enrolled in this study. There was a good distribution of age and level of education. Ethnicity was heavily weighted towards the white population (76.6%) with the next largest ethnic group being East/Southeast Asian (7.8%). The mean total wait-time in clinic was 126.7 ± 46.5 minutes and the mean total VSQ-9 score was 78.5 ± 14.6. The longest time interval experienced by the patients in clinic was waiting for a consultation room after completion of imaging investigations (46.3 ± 33.3 min). The shortest time interval occurred once patients were in the consultation room and waited to be seen by the trainee or surgeon (15.0 ± 9.7 min. There were no statistically significant differences between the total wait-time in clinic, total VSQ-9 scores and age, gender, ethnicity, education, location of injury and overall health. Environmental variables were analyzed and it was found that patients reported greater satisfaction when seen only by the surgeon and not the trainee. Conclusion: Measurement variables have focused on patient satisfaction and wait-time as markers for improving healthcare. Although our study showed that there appears to be no association between any of the variables studied and wait-time or patient satisfaction, interventions at the patient level like using a custom designed clinic traffic flow board to track the position of each patient throughout their follow-up providing patients with a visual estimate of their position relative to other patients in queue may improve patient satisfaction and wait-time.