title: MedlinePlus-based health information prescriptions: a comparison of email vs paper delivery.
abstract: BACKGROUND
  The internet can provide evidence-based patient education to overcome time constraints of busy ambulatory practices. Health information prescriptions (HIPs) can be effectively integrated into clinic workflow, but compliance to visit health information sites such as MedlinePlus is limited.
  
  
  OBJECTIVE
  Compare the efficacy of paper (pHIP) and email (eHIP) links to deliver HIPs; evaluate patient satisfaction with the HIP process and MedlinePlus information; assess reasons for noncompliance to HIPs.
  
  
  METHODS
  Of 948 patients approached at two internal medicine clinics affiliated with an academic medical centre, 592 gave informed consent after meeting the inclusion criteria. In this randomised controlled trial, subjects were randomised to receive pHIP or eHIP for accessing an intermediate website that provided up to five MedlinePlus links for physician-selected HIP conditions. Patients accessing the intermediate website were surveyed by email to assess satisfaction with the health information. Survey non-responders were contacted by telephone to determine the reasons for no response.
  
  
  RESULTS
  One hundred and eighty-one patients accessed the website, with significantly more 'filling' eHIP than pHIP (38% vs 23%; P < 0.001). Most (82%) survey respondents found the website information useful, with 77% favouring email for future HIPs delivery. Lack of time, forgot, lost instructions or changed mind were reasons given for not accessing the websites.
  
  
  CONCLUSIONS
  Delivery of MedlinePlus-based HIPs in clinic is more effective using email prescriptions than paper. Satisfaction with the HIP information was high, but overall response was low and deserves further investigation to improve compliance and related outcomes.
authors.affiliation: Department of Internal Medicine, University of Missouri, Columbia, MO 65212, USA. coberlye@health.missouri.edu
authors.forename: Emily
authors.initials: E
authors.lastname: Coberly
authors.forename: Suzanne Austin
authors.initials: SA
authors.lastname: Boren
authors.forename: Mayank
authors.initials: M
authors.lastname: Mittal
authors.forename: Justin Wade
authors.initials: JW
authors.lastname: Davis
authors.forename: Caryn
authors.initials: C
authors.lastname: Scoville
authors.forename: Rebecca
authors.initials: R
authors.lastname: Chitima-Matsiga
authors.forename: Bin
authors.initials: B
authors.lastname: Ge
authors.forename: Adam
authors.initials: A
authors.lastname: Cullina
authors.forename: Robert A
authors.initials: RA
authors.lastname: Logan
authors.forename: William C
authors.initials: WC
authors.lastname: Steinmann
authors.forename: Robert H
authors.initials: RH
authors.lastname: Hodge
mesh_terms: D022126:Access to Information; D016009:Chi-Square Distribution; D034742:Electronic Mail; D005260:Female; D006801:Humans; D033181:Information Dissemination; D057226:Information Seeking Behavior; D020407:Internet; D008297:Male; D049293:MedlinePlus; D008875:Middle Aged; D008923:Missouri; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D011795:Surveys and Questionnaires