National Engineering Laboratory for Internet Medical Systems and Applications, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
National Telemedicine Center of China, Zhengzhou, Henan, China.
J Med Internet Res. 2020 Sep 3;22(9):e18481. doi: 10.2196/18481.
The internet has caused the explosive growth of medical information and has greatly improved the availability of medical knowledge. This makes the internet one of the main ways for residents to obtain medical information and knowledge before seeking medical treatment. However, little has been researched on how the internet affects medical decisions.
The purpose of this study was to explore the associations between internet behaviors and medical decisions among Chinese adults aged 18 or over, including whether to go to the hospital and which level of medical institution to choose.
With the adult residents (≥18 years old) in 12 regions including urban and rural areas taken as the research objects, the differences in medical choices of adults with various characteristics were analyzed, and generalized linear mixed models were adopted to analyze the longitudinal data of the China Health Nutrition Survey from 2006 to 2015.
Adult groups with different ages, genders, education levels, regions, places of residence, severities of illness and injury, years of suffering from hypertension, and history of chronic diseases showed diverse medical decisions, and the differences were statistically significant (P<.05). After controlling for these potential confounding factors and taking self-care as the reference, the probability of Chinese adults who participated in online browsing activities selecting hospital care was 0.82 (95% CI 0.69-0.98; P=.03) times that of residents who did not participate in online browsing activities. In terms of medical institution choices, adults who participated in online browsing activities were 1.86 (95% CI 1.35-2.58; P<.001) times more likely to opt for municipal medical treatment than primary care. However, the effect of online browsing on the selection probability of county-level hospitals was not significant compared with primary hospitals (P=.59). Robust analysis verified that accessing the internet had a similar effect on Chinese adults' medical decisions.
Chinese adults who use the internet are a little less likely to go to the hospital than self-care. The internet has broken down the barriers to obtain knowledge of common diseases and thus has a slight substitution effect of self-care on hospital care. Internet use may increase the probability of adults going to municipal hospitals. The rising tendency of visiting high-level medical institutions may be consequently exacerbated due to knowledge monopoly of severe and complicated diseases that is difficult to eliminate, and the increase in inconsistent and incomplete medical information online will blur the residents' cognitive boundary of common diseases and severe diseases. Exploring the substantive impact of the internet on medical decision making is of great significance for further rational planning and utilization of the internet, in order to guide patients to appropriate medical institution.
互联网的发展使得医学信息呈爆炸式增长，极大地提高了医学知识的可及性。这使得互联网成为居民就医前获取医疗信息和知识的主要途径之一。然而，关于互联网如何影响医疗决策的研究却很少。
本研究旨在探讨中国 18 岁及以上成年人的互联网行为与医疗决策之间的关系，包括是否去医院以及选择哪家医疗机构。
以城乡成年居民（≥18 岁）为研究对象，分析不同特征成年人医疗选择的差异，采用广义线性混合模型对 2006 年至 2015 年中国健康与营养调查的纵向数据进行分析。
不同年龄、性别、受教育程度、地区、居住地、疾病严重程度和受伤程度、高血压患病年限、慢性病史的成年人群组表现出不同的医疗决策，差异具有统计学意义（P<.05）。在控制这些潜在混杂因素并以自我保健为参照的情况下，参与在线浏览活动的中国成年人选择医院治疗的概率是未参与在线浏览活动的成年人的 0.82 倍（95%CI 0.69-0.98；P=.03）。在医疗机构选择方面，参与在线浏览活动的成年人选择市级医疗机构的概率是选择基层医疗机构的 1.86 倍（95%CI 1.35-2.58；P<.001）。然而，与基层医院相比，在线浏览对县级医院选择概率的影响并不显著（P=.59）。稳健性分析验证了互联网对中国成年人医疗决策的影响具有相似性。
使用互联网的中国成年人去医院的可能性略低于自我保健。互联网打破了获取常见疾病知识的障碍，因此对医院护理有轻微的替代作用。互联网的使用可能会增加成年人去市级医院的概率。由于难以消除严重和复杂疾病的知识垄断，以及互联网上不断增加的不一致和不完整的医疗信息，将模糊居民对常见疾病和严重疾病的认知边界，因此可能会加剧高等级医疗机构就诊率上升的趋势。探讨互联网对医疗决策的实质性影响，对于进一步合理规划和利用互联网具有重要意义，以便指导患者选择合适的医疗机构。
