Informatics in Primary Care (BCS, The Chartered Institute for IT)
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Changing public attitudes to antibiotic prescribing: can the internet help?
Get PDFIntroduction Antimicrobial resistance is a global problem with serious implications for modern medicine. Education of the public is essential for reducing patient pressure on GPs and subsequent inappropriate prescribing. Evaluation of educational interventions is necessary to assess their impact on public knowledge and attitudes. The aim of this study was to evaluate the effect of a health information website, part of the National electronic Library of Infection, on user knowledge and attitudes.
Method Questionnaires testing user knowledge and attitudes before and after using the website.
Results There were significant improvements in knowledge about the use of antibiotics and antibiotic resistance. Expectations that antibiotics should be prescribed were significantly reduced after using the website. Health professionals showed a significantly greater knowledge about antibiotics and were less likely to expect antibiotics to be prescribed for acute otitis media than non-health professionals before using the website. There was no significant difference between the knowledge of these groups after using the website, but non-health professionals continued to have higher expectations of antibiotics being prescribed than health professionals.
Conclusions Health information websites can play a significant role in influencing public knowledge and attitudes. Further research is needed to investigate how people learn from these interventions and to determine their long-term impact on public attitudes and subsequent behaviour
Feasibility of incorporating computertailored health behaviour communications in primary care settings
Get PDFBackground We set out to investigate the feasibility of incorporating a computer-tailored health behaviour program into routine care in a group of primary care practices in Rhode Island.
Methods Two existing computer programs (physical activity, smoking) that tailored text and graphical feedback to survey responses were combined and adapted for use in primary care directly by patients. Ten primary care practices were recruited and worked closely with project staff to develop a practice-specific plan for incorporating the program into the workflow and office routine. Feasibility was measured by the percentage of patients who used the program during the day of their visit.
Results Only one of the ten offices was able to successfully incorporate the program into their office workflow and delivery of routine care. The main categories of barriers to incorporating the computer program into routine care included:
• the program was viewed overall as inconsistent with practice workflow
• the staff was inexperienced with the program
• technical problems with the computer and/or printer
• the program placed an additional time burden on staff who already felt overworked.
Suggestions for improving the program or the way that it was incorporated into routine care included:
• shortening the program
• modifying the program’s orientation to a target population (such as patients with hypertension) and incorporating decision-support feedback to help physicians manage the target condition
• modifying the program to include other programs pertinent to primary care (for example, depression screening)
• selecting patients to use the program, rather than asking all patients to use it.
Conclusions After working closely with ten highly motivated primary care offices, we were unable to fully implement a point-of-care health behaviour computer system for patients and providers. Suggestions for disseminating computer-tailored health behaviour communications in primary care settings are discussed
The electronic immediate discharge document: experience from the South West of Scotland
Get PDFBackground Communication and transfer of information between healthcare professionals are essential to a seamless healthcare process, and are vital for ensuring that there is smooth transition of care for patients. Throughout the National Health Service (NHS) Scotland, there is a wide variability in the quality and quantity of information provided in the immediate discharge document (IDD).
Aims To analyse general practitioner (GP) attitudes and responses on the quality and efficacy of an electronic IDD (e-IDD).
Setting All GPs in Dumfries and Galloway.
Methods GPs communicating electronically with the hospital were sent a survey questionnaire at the end of an 18-month pilot.An amended questionnaire surveying potential interest was sent to the remaining GPs in the region.
Results The overall response rate was 70%. Eightyone percent of practices connected received the e-IDD regularly, but the majority still used it in conjunction with its postal equivalent. Seventy percent complained of inadequacies in content relating to medication and follow-up information. Eighty percent agreed that it was faster and 68% felt significant cost savings could be made. Eighty-eight percent wanted a multidisciplinary input. Concerns were raised about funding, need for adequate training and back-up systems. Ninety-six percent were optimistic that in future other forms of clinical communications could be sent electronically.
Conclusion Discharge content is more important than delivery method. Emphasis should be placed on ensuring standards are met on the quality and quantity of current e-discharge documents. Further clarification is required on patient confidentiality issues and legal validity of electronic patient records. E-health is to play a larger and ever-increasing role in the NHS in Scotland
Quality of diagnostic coding and information flow from hospital to general practice
Get PDFAims To describe the transfer of patient information from hospital to general practice and compare the quality of coding of patient diagnoses in hospital and general practice systems.
Method Setting: Wellington Hospital and patients registered with 12 general practitioners (GPs) from two local computerised general practices. Discharge and outpatient letters for the period June to August 2003 were analysed and diagnostic coding compared between letters and electronic health records (EHR) in hospital and general practice. A questionnaire was sent to 167 consultants and 112 GPs from Wellington city region with a 71% response rate.
Results GPs received 55% of 284 discharge letters and 97% of 612 outpatient letters with a mean time of 9.4 days (range 0–70 days) and 14 days (range 0–120 days). The mean number of diagnostic codes recorded in discharge letters was 2.9 per letter, in the GPs’ EHR 0.9 per letter, and in the hospital EHR 3.5 per letter. GPs were sent new diagnostic information in 30% of discharge and 36% of outpatient letters. There was more coding agreement between GPs’ EHR and discharge letters than between the hospital EHR and discharge letters (65% versus 35%). GPs duplicated coding for 71% of all letters, and 74% of diagnoses were coded within the classification section of the GPs’ EHR. More GPs than hospital doctors coded patient diagnoses (85% versus 15%), had any formal training in coding (25% versus 2%), and thought coding improved patient care (75% versus 50%). Most doctors in both groups experienced considerable delay of information flow and favoured an electronic transfer of information.
Conclusions There is delay in information flow from hospital to general practice and poor comparison of diagnostic coding across the two systems. Attitudinal differences and inefficient coding practices will need to be addressed to produce an integrated information system between hospital and general practice
Primary care physicians’ experiences of carrying out consultations on the internet
Get PDFBackground The internet is increasingly used for health matters, including consulting a doctor. Primary care physicians (general practitioners) will probably be involved in performing text-based consultations on the internet as a complement to physical meetings. In the present study, we explored the experiences of GPs already performing consultations on the internet: the challenges, worries and educational demands of the task.
Materials and methods A questionnaire was given to 21 GPs performing consultations on the internet for a public, non-commercial ‘ask the doctor’ service. The questionnaire was carried out at a meeting or sent by mail. The doctors answered a total of 28 questions, 12 of which included graded alternatives.
Results The participating GPs were stimulated and challenged by performing consultations on the internet with previously unknown enquirers, in spite of limitations caused by the lack of personal meetings and physical examinations. The participants experienced a high educational value as a result of the problem-based learning situation induced by unfamiliar questions. The asynchronous feature was appreciated as it allowed time to reflect and perform relevant information searches before replying. Prior training and long-term experience as a family doctor were recommended before embarking on this method of consultation.
Conclusions We conclude that the GPs studied experienced their new role as internet doctors mainly in a positive way, with some limitations. With the increase in consultations on the internet, training in this technique should be integrated into the curricula of medical schools and of continuous professional development (CPD)
The roles of ‘subjective computer training’ and management support in the use of computers in community health centres
Get PDFThere have been many changes made to information systems in the last decade. Changes in information systems require users constantly to update their computer knowledge and skills. Computer training is a critical issue for any user because it offers them considerable new skills. The purpose of this study was to measure the effects of ‘subjective computer training’ and management support on attitudes to computers, computer anxiety and subjective norms to use computers. The data were collected from community health centre staff. The results of the study showed that health staff trained in computer use had more favourable attitudes to computers, less computer anxiety and more awareness of others’ expectations about computer use than untrained users. However, there was no relationship between management support and computer attitude, computer anxiety or subjective norms. Lack of computer training for the majority of healthcare staff confirmed the need for more attention to this issue, particularly in health centres
A survey of GP attitudes to and experiences of email consultations
Get PDFEmail is an accepted part of modern communication in business and education. The use of email could benefit communication between patients and healthcare professionals. Use of email within health care has been hampered by concerns about privacy, technical barriers, perceived fear of change and increased workload. Sixty-two general practitioners within Dundee in east Scotland responded to a questionnaire and indicated that they regularly used email for communication within their practices and with outside agencies, but rarely with patients. Many perceived a need to provide an email service for clinical enquiries and repeat prescription requests but felt constrained from doing so by a lack of an accepted system and workload concerns