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GPs using unreliable websites for tinnitus information, study finds

September 13, 2012
GPs are not always using the most comprehensive and reliable online resources to support them in treating patients with the debilitating hearing condition tinnitus, researchers have found.

The study looked at the 10 main websites used by GPs to get information on clinical practice and found that the two best websites for assessing or managing tinnitus - Map of Medicine and the British Tinnitus Association (BTA) - were rarely used by family doctors, with only two per cent logging on to access their pages.

The research, which involved a team of experts from The University of Nottingham, Nottingham Trent University and the National Institute for Health Research (NIHR) National Biomedical Research Unit in Hearing, is published in the latest edition of the journal BMC Medical Informatics and Decision Making.

Dr Derek Hoare, Senior Research Fellow at The University of Nottingham and the NIHR National Biomedical Research Unit in Hearing, said: "We found that there are better options for sources of online information than those currently used by most GPs. Map of Medicine in particular used a rigorous and explicit approach to reporting making its sources of information very transparent and reliable, while The British Tinnitus Association website came out top for the quality of information it currently provides on treatment choice. Despite this, these two websites are rarely used by GPs.
Lacking details

"However, when we analysed the content of the group of websites we found that all were lacking a number of details relating to either assessing or managing tinnitus and so GPs may have to use a combination of websites to be fully informed. Our report also offers a range of recommendations that will help providers of online tinnitus websites to improve their resources."

Tinnitus, a condition in which patients hear a persistent ringing, hissing or buzzing sound in their ears, affects around 10 per cent of the population and is often associated with other illnesses including stress, anxiety, insomnia, depression and communication difficulties.

Patients usually access NHS services such as neurotology or audiological rehabilitation through their GPs. However, a recent national survey of GPs by the research team highlighted that many feel their knowledge of tinnitus is limited and they need better guidelines on how to effectively assess, diagnose and refer their patients.
Inappropriate referrals

In addition, patients with hearing problems expressed concern of poor GP awareness of the condition and other healthcare professionals such as audiologists highlighted inappropriate referrals received from GPs.

As tinnitus is seen to affect a relatively low number of patients at GP surgeries, many doctors are turning to the internet for information on the condition rather than spending resource on specialist training.

However, while the internet can provide instant access to a diverse range of sources, the volume of information available can often make it difficult for GPs to discern between the sites offering sound advice on the management of the condition and those which are inaccurate and unreliable - a Google search of 'tinnitus treatment' generates 11 million results alone.

The research analysed the content of 10 of the sites most commonly used by GPs - which included commercial, charity and Government-run websites - and used a specialist healthcare information score called DISCERN to rate the quality of the information they offered and their usability.

The study found that the Map of Medicine, ranked highest overall for quality and reliability despite achieving a low score for information on the management of tinnitus. Conversely, the BTA site, which was ranked in second place, had one of the highest scores on information on management choices.
Valuable information

The results indicate that GPs would have to visit at least two websites to gather all the information recommended by the Department of Health for good practice in tinnitus care, which is unlikely to happen in a busy practice.

Ironically, the lowest rated website was the NHS patient health information site NHS Choices. Both the highest and the lowest websites were accredited by The Information Standard.

The report recommends that GPs use both the Map of Medicine and the BTA sites as education tools on tinnitus, or more simply, to use the good practice guide on tinnitus produced by the Department of Health.

The research will also offer valuable information for websites providing information on tinnitus on how they can improve their service and Action on Hearing Loss has already gathered the preliminary findings to be incorporated into a forthcoming overhaul of its website.

The research was conducted by Miss Kathryn Fackrell (Nottingham Trent University), Dr Derek Hoare, Mrs Sandra Smith and Dr Abby McCormack (The University of Nottingham and the NIHR National Biomedical Research Unit in Hearing) and Professor Deborah Hall (Nottingham Trent University and the NIHR National Biomedical Research Unit in Hearing).

Support and funding for the research came from Action on Hearing Loss and the National Institute for Health Research (NIHR) Biomedical Research Unit Programme.

A copy of the paper is available to view online at

The National Institute for Health Research (NIHR)

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