Are your patients among the estimated 100 million Americans logging on to the Internet for health information? If so, a recent study published in the Journal of the American Medical Association says they should consult you before basing health care decisions on what they find. Information posted on medical Web sites is often incomplete and difficult to read, the report says.

While the health information found was generally accurate, search engines proved to be inefficient tools for locating relevant content and health sites lacked key clinical elements identified by physicians. The problem appears to be worse on Spanish-language sites.

“Although we found thousands of pages of material related to key questions, there were substantial gaps in the availability of key information,” the report says. About half of the topics expert panels deemed important were given more than minimal coverage on English-language Web sites. “The deficiency was particularly striking across Spanish-language sites where more than half of the condition-related topics were not addressed,” the report says.

Researchers at the RAND Corporation, a Santa Monica, Calif., think tank, searched the Web over a period of six months for information on four medical conditions: breast cancer, childhood asthma, depression and obesity. Using several popular search engines, they found that less than a quarter of the first pages of links rendered by a search led to relevant content. According to the report, more than half of Internet users report they spend only about half an hour looking for health information. That doesn’t leave a lot of time to sift through irrelevant material.

Researchers employed panels of physicians to list clinical elements they thought would be important to people looking for information on the four medical conditions studied. For English-language sites, researchers found that more than a quarter of the elements listed for childhood asthma were not mentioned. More than a third of the elements listed for obesity were absent. For Spanish-language sites, 69 percent of the elements for obesity and 61 percent of the elements for depression were not discussed.

Some specific examples of deficiencies are: 

• 61 percent of clinical elements relating to safety and effectiveness of dietary supplements used for obesity were not covered on English sites. No mention was found of these elements on Spanish sites.

• Few sites advised that a woman with a persistent breast mass and a negative mammogram seek more testing.

• Almost no sites advised people with suicidal thoughts to see their doctor

• Few sites discussed the symptoms of an asthma attack.

The study also showed that health information on the Internet requires a high level of reading skill. English sites averaged a rating of grade 13.2 on the Fry Readability Graph, as they ranged from grade 10 to graduate level. Spanish sites averaged grade 9.9. The study says that according to a 1992 survey on adult literacy, nearly half of the U.S. population has low or very low reading skills. Researchers concluded that even if wider access to computers were available, today’s online health information would be difficult for many to understand.

“If people are relying on the Internet to make treatment decisions, including whether to seek care, deficiencies in information could negatively influence consumer decisions,” the report says. The report was published in the May 23 edition of JAMA.

Some sites you might recommend to patients

Of the Internet health sites RAND studied, these scored highest:

www.Oncolink.com–a breast cancer site by the University of Pennsylvania

www.nimh.nih.gov–a depression site by the National Institutes of Health

AAFP is encouraging physicians to direct patients battling high blood pressure to a new page on the National Heart, Lung, and Blood Institute’s Web site. Patients can find tips on diet and exercise, healthy recipes and other information to help them control their condition. The address is: www.nhlbi.nih.gov/hbp/

The magazine, Family Practice Management, recently published an article listing several good health-related Web sites. Here are a few you or your patients might find useful:

www.rxassist.org–site sponsored by the Robert Wood Johnson Foundation containing information on the patient assistance programs for more than 100 pharmaceutical manufacturers

www.noah-health.org, www.drpen.com, and www.familydoctor.org all contain multilingual patient education information

www.immunize.com–provides information on immunization and vaccination in 17 different languages.