Health-related Internet use among patients of osteopathic physicians.

CONTEXT: Using the Internet has transformed communication and improved access to health-related information for patients and physicians. OBJECTIVE: To determine why patients use the Internet for health-related information, where patients find answers to their questions, and whether patient use of the Internet impacts the patient-physician relationship. This study focused on patients of osteopathic physicians to confirm previously published data in a more specific population. METHODS: An anonymous 25-item survey was distributed to patients in a primary care setting. The survey elicited information regarding demographics, health-related Internet use, and discussion of Web-based health information during the clinical visit. RESULTS: Two hundred eighty-five patient surveys were collected. Data based on sex, age, education level, and ethnicity were evaluated. Two hundred fifty of 280 patients (89%) reported that they use the Internet to find health-related information, and 134 of 250 patients (54%) indicated that they changed their health-related behaviors based on information they found. Seventy-three of 133 patients (55%) who changed their behaviors reported these findings to their physicians. This finding differed by age and ethnicity. Patients aged 50 to 64 years (22 responses, 73%) were the most likely group to report behavioral changes to their physicians (P=.048). No patients who identified themselves as of Asian/Pacific Islander descent indicated that they reported behavioral changes to their physician (P=.043). Two hundred forty-two of 261 patients (93%) reported that their personal physician is the most reliable source for health information. CONCLUSION: Most patients use the Internet to find health-related information, but many of them are not reporting potentially important health-related behavioral changes to their physicians. However, most patients still consider their physician as the most reliable source for health-related information. Physicians should ask patients about Internet use and counsel them about where to find reliable, accurate, high-quality health information.

Assessing your office for care of lesbian, gay, bisexual, and transgender patients.

Practitioners act as guide, protector, and confidant to their patients' most vulnerable health care concerns. Arguably, one of the most important times to consider the dynamics of a health care relationship is when treating culturally diverse populations such as lesbian, gay, bisexual, and transgender (LGBT) patients. This article outlines several recommendations for how physicians can begin the process of assessing their office and practice habits for supportive care of LGBT patients, including evaluating your belief systems, understanding risk factors associated with LGBT patients, modifying medical intake forms and interview practices, reviewing staff training and office procedures, and becoming familiar with available tools and resources. With several minor but effective changes, you can offer your LGBT patients a practitioner who is (1) knowledgeable of relevant LGBT health care and basic human sexuality, (2) mindful and sensitive to the needs of diverse sexual and gender identities, and (3) capable of making interpersonal and office-related adjustments for the purpose of providing them with the best possible medical care.

Potential for pregabalin abuse or diversion after past drug-seeking behavior.

Pregabalin, primarily used to manage neuropathic pain and fibromyalgia, is categorized as a Schedule V drug (ie, lowest potential for abuse) in the US Drug Enforcement Administration's Controlled Substances Act. Because pregabalin is not recognized as a drug with high-abuse potential, data on pregabalin abuse and addiction are lacking. The authors report a case of a 35-year-old woman with a history of opioid-seeking behavior who was prescribed pregabalin for pain control. The patient requested an increase in her medication 2 months after beginning treatment and, after her physician denied her request, subsequently obtained pregabalin from other sources. Over a 28-day period, the patient received a total of 88,500 mg of pregabalin. After learning of the other prescriptions, the patient's physician became suspicious of pregabalin abuse or diversion. In accordance with state medical board guidelines, the patient was discharged from the practice and referred to a local detoxification center.

Eliminating barriers for patients with limited English proficiency.

The increasing number of patients with limited English proficiency (LEP) in the United States is an important issue for patients, physicians, federal and state government agencies, and insurance carriers. Physicians can actively address this healthcare barrier by becoming familiar with established state and federal guidelines and determining when appropriate linguistic services are required for their LEP patient populations. Physicians can ensure that appropriate care is administered to LEP patients by developing and monitoring plans that include training staff to identify and work with LEP patients, providing language assistance to LEP patients, and notifying LEP patients of special services.

Continuous opioid treatment for chronic noncancer pain: a time for moderation in prescribing.

Physicians have embraced the concept of long-term opioid treatment for chronic noncancer pain (CNCP), as evidenced by increased prescribing. Many patients have benefited from more liberal opioid prescribing, but many have not, and prescription opioid abuse has risen significantly coincident with increased prescribing. Because of the potentially serious adverse effects of opioids, physicians must balance potential benefits against risks, especially in individuals at risk for opioid misuse, abuse, or dependence. This article reviews long-term, continuous opioid treatment of CNCP, current treatment guidelines, addiction risk stratification, opioid-induced hyperalgesia, and endocrine dysfunction.

Opioid-induced endocrinopathy.

Debilitating chronic nonmalignant pain is often managed using opioid medications. However, with increased use of this drug class comes concern about adverse effects on patients' endocrine function. In the present review, the authors discuss opioid-induced interference with the hypothalamic-pituitary-gonadal axis, effects on adrenal androgen production, and endocrine deficiency. In addition, the authors describe symptomology for opioid-induced endocrinopathy as well as diagnostic testing options. Treatment modalities for those afflicted with this condition are also described.