The specific aim of this proposed project is to implement a standard process for integrating MedlinePlus health information prescriptions into the clinic workflow.

Hypothesis 1: Individuals in the intervention group who receive tailored email health information with provider selected MedlinePlus links and added commentary for patient specific conditions will be more likely to seek information / use MedlinePlus compared with individuals in the control group.

Hypothesis 2: Individuals in the intervention group who receive tailored email health information with provider selected MedlinePlus links and added commentary for patient specific conditions will be more satisfied with the information received compared with individuals in the control group.

Providing patient education in an outpatient practice can be challenging in part due to the variety of patient medical conditions and the quantity of materials needed. Increasingly, electronic resources such as those found on the internet have the potential to provide easily accessible needed information. However, clinicians do not have the time to assemble a list of websites for their patients and even if they did, the quality of information varies greatly and would require close screening. MedlinePlus is a free National Library of Medicine sponsored website that features health information on hundreds of conditions with all information carefully screened for quality standards by expert librarians. We will conduct a pilot study to seamlessly integrate provider-customized MedlinePlus health education prescriptions for specific conditions into the normal clinic workflow to motivate patients to access and expand their use of MedlinePlus to benefit their health. As HIV prevention/education is very important, we will include the HIV clinic as well as a general internal medicine clinic.

• Allergic Rhinitis
• Asthma
• Back Pain
• Benign Prostatic Hypertrophy
• Bursitis
• Depression
• Anxiety
• Diabetes Mellitus
• Esophageal Reflux
• HIV Infections
• Hyperlipidemia
• Hypertension
• Insomnia
• Irritable Bowel Syndrome
• Obesity
• Osteoporosis (Senile)
• Shoulder Pain
• Sinusitis
• Symptomatic Menopause
• Urinary Incontinence
• Urinary Tract Infection
• Vaginitis

• No Intervention:
  1. While patient is waiting in exam room for physician, a research assistant will enter the exam room and speak with the patient.
  2. The research assistant will record the patient's name, willingness to share email, and willingness to participate in the study at the time of the patient encounter. She will later collect their address, gender, age, date of visit, clinic name, and billing diagnoses from IDX data after leaving the exam room.
  3. Physician evaluates the patient and documents the diagnoses for the clinic visit on the billing sheet as per their usual practice. At the end of the clinic session/day, the research assistant will review the billing sheets and record all the listed diagnoses for the control patients.
  4. The research assistant mails the control patients a f/u survey within one week of clinic visit. The surveys will be coded to correspond to diagnosis from billing data.
• Experimental:
  1. PSR hands the patient the Health Information Prescription (HIP) order form, and patient writes their name at the top of the form. HIP order form will ask if patient uses email, and if they would be willing to share their email address.
  2. Physician evaluates the patient, tells the patient they are ordering a Health Information Prescription, and checks a diagnosis on the HIP form.
  3. Patient returns to PSR to check-out. If patient has an HIP order, PSR refers patient to the research assistant.
  4. The research assistant will record patient name, email address, willingness to participate in the study, and diagnosis at that time, and have patient sign consent and HIPAA authorization. She will later obtain age, date of visit, clinic name, address and diagnoses from billing data from IDX.
  5. The research assistant sends the HIP email within 24 hours of the visit, and mails the survey within 5 business days of clinic visit.

Inclusion Criteria:

• To be included in the study population, patients must also be seen by their physician for one of the 21 target health conditions (Allergic Rhinitis, Asthma, Back Pain, Benign Prostatic Hypertrophy, Bursitis, Depression/Anxiety, Diabetes Mellitus, Esophageal Reflux, HIV, Hyperlipidemia, Hypertension, Insomnia, Irritable Bowel Syndrome, Obesity, Osteoporosis (senile), Shoulder Pain, Sinusitis, Symptomatic Menopause, Urinary Incontinence, Urinary Tract Infection, Vaginitis) and be willing to provide an email address.
• Patients will be included only once.
• All patients in the intervention and the control group will receive the survey.
• All physicians and staff at the Fairview Clinic and HIV Clinic will be invited to complete the physician or staff survey.

Exclusion Criteria:

• No email address