Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Adoption of information technology in primary care physician offices in New Zealand and Denmark, part 2: historical comparisons
Get PDFThis second paper in a series of five looks at how computing in primary care began and provides background to the driving forces for automation in Danish and New Zealand primary care physician offices. It addresses topics such as government funding support, the role of professional colleges and associations, peer influence, change management, and comparative cultures. It also highlights the power of a unifying organisation and introduces the concept of a Health Systems Integrator
Needing smart home technologies: the perspectives of older adults in continuing care retirement communities
Get PDFBackground At present, the vast majority of older adults reside in the community. Though many older adults live in their own homes, increasing numbers are choosing continuing care retirement communities (CCRCs),which range from independent apartments to assisted living and skilled-nursing facilities. With predictions of a large increase in the segment of the population aged 65 and older, a subsequent increase in demand on CCRCs can be anticipated. With these expectations, researchers have begun exploring the use of smart home information-based technologies in these care facilities to enhance resident quality of life and safety, but little evaluation research exists on older adults' acceptance and use of these technologies.
Objective This study investigated the factors that influence the willingness of older adults living in independent and assisted living CCRCs to adopt smart home technology.
Subjects and setting Participants (n = 14) were recruited from community-dwelling older adults, aged 65 or older, living in one of two mid-western US CCRC facilities (independent living and assisted living type facilities).
Methods This study used a qualitative, descriptive approach, guided by principles of grounded theory research. Data saturation (or when no new themes or issues emerged from group sessions) occurred after four focus groups (n = 11 unique respondents) and was confirmed through additional individual interviews (n = 3).
Results The findings from this study indicate that although privacy can be a barrier for older adults' adoption of smart home technology their own perception of their need for the technology can override their privacy concerns.
Conclusions Factors influencing self-perception of need for smart home technology, including the influence of primary care providers, are presented. Further exploration of the factors influencing older adults' perceptions of smart home technology need and the development of appropriate interventions is necessary
A visual study of computers on doctors' desks
Get PDFBackground General practice has rapidly computerised over the past ten years, thereby changing the nature of general practice rooms. Most general practice consulting rooms were designed and created in an era without computer hardware, establishing a pattern of work around maximising the doctor-patient relationship. General practitioners (GPs) and patients have had to integrate the computer into this environment.
Methods Twenty GPs allowed access to their rooms and consultations as part of a larger study. The results are based on an analysis of still shots of the consulting rooms. Analysis used dramaturgical methodology; thus the room is described as though it is the setting for a play.
Results First, several desk areas were identified: a shared or patient area, a working area, a clinical area and an administrative area. Then, within that framework, we were able to identify two broad categories of setting, one inclusive of the patient and one exclusive.
Conclusion With the increasing significance of the computer in the three-way doctor_patient_computer relationship, an understanding of the social milieu in which the three players in the consultation interact (the staging) will inform further analysis of the interaction, and allow a framework for assessing the effects of different computer placements
Evaluation of the MoleMateTM training program for assessment of suspicious pigmented lesions in primary care
Get PDFBackground Pigmented skin lesions or 'moles' are a common presenting problem in general practice consultations: while the majority are benign, a minority are malignant melanomas. The MoleMateTM system is a novel diagnostic toolwhich incorporates spectrophotometric intracutaneous analysis (SIAscopy) within a non-invasive scanning technique and utilises a diagnostic algorithm specifically developed for use in primary care. The MoleMateTM training program is a short, computer- based course developed to train primary care practitioners to operate the MoleMateTM diagnostic tool.
Objectives This pre-trial study used mixed methods to assess the effectiveness and acceptability of a computer-based training program CD-ROM, developed to teach primary care practitioners to identify the seven features of suspicious pigmented lesions (SPLs) seen with the MoleMateTM system.
Method Twenty-five practitioners worked through the MoleMateTM training program: data on feature recognition and time taken to conduct the assessment of each lesion were collected. Acceptability of the training program and the MoleMateTM system in general was assessed by questionnaire.
Results The MoleMateTM training program improved users' feature recognition by 10% (pre-test median 73.8%, p<0.001), and reduced the time taken to complete assessment of 30 SPLs (pre-test median 21 minutes 53 seconds, median improvement 3 minutes 17 seconds, p<0.001). All practitioners' feature recognition improved (21/21), with most also improving their time (18/21). Practitioners rated the training program as effective and easy to use.
Conclusion The MoleMateTM training program is a potentially effective and acceptable informatics tool to teach practitioners to recognise the features of SPLs identified by the MoleMateTM system. It will be used as part of the intervention in a randomised controlled trial to compare the diagnostic accuracy and appropriate referral rates of practitioners using the MoleMateTM system with best practice in primary care
Do electronic medical record (EMR) demonstrations change attitudes, knowledge, skills or needs?
Get PDFIntroduction Electronic medical records (EMRs) are the future of primary care. Transition to electronic records can have a significant impact on physicians, office staff, nursing staff and patients. There are no published EMRstudies combining these four populations or studies that have evaluated the impact of EMR demonstrations. To better understand the impact of EMRs, an online survey was administered before and after EMR demonstrations.
Methods A longitudinal cohort survey design was used to assess primary outcomes (attitudes, knowledge, skills and needs) related to EMRs in four populations that were divided into two groups - one of physicians and the other of nursing staff, office staff and patients. A total of 39 participants (19 physicians and 20 staff/patients) completed a pretest survey four weeks prior to and post-test surveys at four and ten weeks after EMR demonstrations. Mean composite scores for each primary outcome were calculated for each group and mean differences were calculated and compared within and between groups - from baseline to four weeks and four to ten weeks using paired t-tests and Student's t-tests, respectively.
Results Groups differed in several areas: physicians were younger, had more education and had fewer years of experience in a primary care office. There were no significant differences in gender or computer experience between groups. Staff/patients reported significant improvements in attitudes, knowledge and needs from baseline to four weeks (P<0.05, P<0.01 and P<0.05). Physician attitudes, knowledge and needs significantly increased at week four (P<0.05, P<0.01 and P<0.05). Attitudes, knowledge and needs were sustained in both groups from week four through to week ten.
Conclusion EMR demonstrations improved attitudes, knowledge and needs of staff/patients and physicians. EMR demonstrations may be effective in favorably influencing healthcare personnel towards EMRs
The use and effectiveness of electronic clinical decision support tools in the ambulatory/primary care setting: a systematic review of the literature
Get PDFBackground The 1999 Institute of Medicine (IOM) report To Err is Human alerted the healthcare industry and the public to the lack of consistency in the delivery of quality care to the US population. Clinical decision support systems (CDSS) have become a leading response to this report, and to the growing demand for the promotion of standards- based care delivery. The objective of this paper is to evaluate the recent literature for both the types and effectiveness of electronic CDSS in the primary care setting.
Methods An electronic search of the literature wasconducted utilising MEDLINE (1996_2006),CINAHL (1982_2006) and all EBM Reviews - Cochrane DSR, ACP Journal Club, DARE and CCTR. The search included various combinations of the MeSH search terms 'clinical decision support systems', 'primary health care', 'ambulatory care' and 'practice guidelines' and was limited to articles published from 2000 to 2006. Studies were selected for review if they involved either non-randomised observational or randomised controlled trials (RCTs) utilising CDSS as a single intervention, were performed in an ambulatory primary care setting and included quantifiable outcome measures.
Results Seventeen studies were included in the review, including five non-randomised observational studies and 12 RCTs. Thirteen studies (76%) found either positive or variable outcomes related to CDSS intervention with four studies (24%) showing no significant effect.
Conclusion Although there is validation that CDSS has the potential to produce statistically significant improvement in outcomes, there is much variability among the types and methods of CDSS implementation and resulting effectiveness. As CDSS will likely continue to be at the forefront of the march toward effective standards-based care, more work needs to be done to determine effective implementation strategies for the use of CDSS across multiple settings and patient populations
Strategic considerations for improving the quality of eHealth research: we need to improve the quality and capacity of academia to undertake informatics research
Get PDFThe impact of the internet on the practice of general practitioners and community pharmacists in Northern Ireland
Get PDFObjective The objective of this study was to gain an insight into the use of the internet for practice-related purposes by community pharmacists and general practitioners (GPs) in Northern Ireland, and to gather information about their experiences relating to patients and the internet.
Method A postal questionnaire survey of all community pharmacies (n=522) and all GPs practising in Northern Ireland (n=1081).
Results A total of 542 completed questionnaires were returned, giving an overall response rate of 34%. The majority of respondents had access to the internet in their workplace, and approximately 60% of respondents in each profession accessed health-related websites on up to five occasions per week. Of those who did not access health-related websites, lack of time was the main reason cited. The most popular sites for both professions were online journals. Significant differences were found in the activities undertaken by the two professions whilst online. Significantly more GPs than community pharmacists reported searching for disease-related (non-drug) information, using web-based disease management tools or reading online journal articles. Few respondents reported recommending websites to patients, although significantly more GPs than pharmacists did so. Significantly more pharmacists had been approached or felt challenged by patients who had downloaded information from the internet. GPs were more likely to communicate with colleagues about patients by email but neither profession reported frequent correspondence with patients by email.
Conclusions Both professions used the internet regularly as a source of health-related information and both had to deal with 'internet-informed', (or sometimes misinformed) patients. Community pharmacists were more likely to feel challenged by these patients and GPs sometimes had to deal with unnecessarily worried patients or patients with unrealistic expectations. Both professions will have to change working practices to accommodate the impact of the internet. This will have significant future training implications
