gms | German Medical Science

Background: Easily accessible health information on the internet can be a powerful tool to improve health care. However, much information on the internet is of poor quality and many patients feel unable to appraise its quality. Therefore, we developed the web portal tala-med providing evidence-based, up-to-date and easy to understand information about lower back pain. Tala-med is designed to be used by general practitioners (GPs) and patients during and following back pain consultations.

Objective: To evaluate the effectiveness of tala-med on patients’ informedness about back pain (primary outcome) as well as on the physician-patient communication, patients’ perceived efficacy in patient-physician interactions, patients’ health literacy, and their back pain (secondary outcomes).

Method: We conducted a prospective cluster-randomized trial with N = 316 back pain patients treated by N = 45 GPs. GPs were randomly assigned to an intervention group (IG) and a control group (CG). GPs in the IG should use tala-med in the consultation and recommend it to their patients. GPs in the CG had no access to tala-med and should perform their usual consultation. Patients completed paper-pencil surveys before (t0) and immediately after the consultation (t1), as well as four weeks later (t2). Hypotheses were tested with multilevel analyses.

Results: Regarding the primary outcome, patients in the IG increased their knowledge about back pain from t0 to t2 more than patients in the CG (d = 0.39; p < .01) and were more informed about back pain at t2 (d = 0.61; p < .01) than the CG. The proportion of patients with at least minimal clinically significant improvements of knowledge was 43% in the IG and 27% in the CG. Effects on the secondary outcome physician-patient communication depended on GPs’ use of the portal in the consultation. Patients whose GP introduced it in the consultation perceived more shared decision making than patients in the CG (d = 0.49, p < .05). Patients whose GP did not explain it were less satisfied with the GP’s communication (d = -0.61, p < .01) and the consultation (d = -0.45, p < .05) than the CG. Patients in the IG also showed more increase of perceived efficacy in patient-physician interactions (d = 0.36, p < .05) and of aspects of health literacy (ds ≥ 0.29, ps < .05), and better improvement in back pain (d = -0.47, p < .05) than patients in the CG.

Discussion: The results provide evidence for the effectiveness of the web portal tala-med as the primary outcome patients’ informedness increased statistically and clinically significant. They also support tala-med’s effectiveness on the secondary outcomes perceived efficacy in patient-physician interactions, health literacy, and back pain. Last, the results indicate that tala-med can be beneficial for the physician-patient communication, but it can also be detrimental, if GPs just give their patients the access to the web portal without introducing it in the conversation.

Practical implications: GPs can use web portals such as tala-med to enhance patients’ informedness about back pain, their participation, health literacy and self-management of back pain.

Appeal for practice in one sentence: Using GP-introduced and evidence-based web portals helps patients to find quality-assured information for good health.

Funding: Innovationsfonds/Versorgungsforschung; 01NVF17010