"Stepped care": a health technology solution for delivering cognitive behavioral therapy as a first line insomnia treatment.
Espie CA.
Sleep. 2009 Dec 1;32(12):1549-58. Review.
PMID: 20041590 [PubMed - indexed for MEDLINE]
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Does online help replace Doctors? No. Quality online venues enhance the treatment options for doctors and provide access to professional care that cannot otherwise be found in many areas.

Our company hasn’t even begun to market our SleepCoach service (www.sleepcoach.net) and already people are signing up and referring their friends. There is also evidence from increasing sales of online behavioral therapy and LifeCoach services to major insurance companies and EAPs. Although behavioral health may be more amenable to online work than say, cancer treatment.

Working for an online company that delivers a continuum of care both online and off-line, I stay very conscious of not “drinking the cool-aid.” Our company needs to be grounded in the reality of where the market is going. Three sets of data offer strong evidence that the future is in some form of online medical delivery (at least in behavioral health). 1.The dollars spent by private paying individuals in the US, Canada and overseas, points to a dramatic rise in the use of online treatment. 2. Major insurance companies are spending millions on the development of online products. 3. State entities are reaching out to us to create virtual online service delivery systems.

Polling is only as good as the methodology of the polling, the questions posed, the population questioned and the sample size. Our “Pocket book” research could possibly be measuring early adopters of technological solutions. But it is clear that they are adopting in droves. Combined with the overall trends in email and internet usage, it is a just a matter of time before online delivery of medicine is mainstream.

Will this displace providers? I don’t think it will ever replace them. Our model is to provide an integrated continuum of care so people can do self-help and then reach out to a professional when they need one. I think humans will always want a bit of the human touch.

Thanks for sharing your focus group findings. Your findings are consistent with with numerous studies which show that the “average” patient asks their doctor very few questions (if any) during routine office visits irrespective of medical problem. The reasons given include those you cited…fear of looking stupid, sense that the doctor was pressed for time, etc.

I am curious if you explored ways of increasing patient participation (e.g, question-asking) during the medical interview?

You confirm that gaining access to the Internet changes the nature of the interaction between patients and health professionals.

That is really part of the tectonic shift and that is why Participatory Medicine can only exist and grow with networked e-patients.

I wonder how long it will take to see changes in all medical school curriculums integrating the changing roles of the patient and HC professionals in the care process.

Thanks so much for expanding our quick Twitter conversation into this thoughtful comment. I really like your idea of segmenting the patient population – I’ll definitely consider this when Pew Internet is designing our next health survey.

Here is her bio:
http://patienteducation.stanford.edu/lorig.html

And here is her introductory piece for the Journal of Participatory Medicine:

What It Will Take to Embrace Participatory Medicine: One Patient’s View
http://jopm.org/index.php/jpm/article/view/14/17