Informatics in Primary Care (BCS, The Chartered Institute for IT)
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The development and evaluation of a computerised decision support system for primary care based upon 'patient profile decision analysis'
Get PDFObjective To develop and evaluate in primary care a computerised decision support system for the management of stroke patients based upon 'patient profile decision analysis'.
Design The decision support system incorporated the findings of 960 Markov models examining the decision to prescribe aspirin in the secondary prevention of stroke. The models reflected each combination of nine risk factors that determined a patient's profile. The evaluation comprised a qualitative interview and a questionnaire administered before and after the general practitioners (GPs) were given access to the support system.
Setting Primary care.
Participants 15 GPs from the West Midlands.
Main outcome measures Decision certainty scoring of hypothetical patient vignettes. Qualitative perceptions of the applicability and acceptability of the system for primary care.
Results After using the system, GPs were more certain of their decision making and made decisions more in line with national guidelines. Quantitative results further suggested that the system made decision making easier, improved feelings of being supported, improved the quality of decision making and increased satisfaction. Qualitative themes included that GPs thought the system could clarify their own decision making and improve GP_patient dialogue.
Conclusions The feasibility of individualised decision analysis for general practice has been questioned. Patient profile decision analysis, however, may be a valuable means of harnessing some of the advantages of the methodology to produce more patient-specific guidelines for primary care
Diversity, equal access and information
Get PDFThe overall aim of diversity is to ensure that every individual, whatever their differences, has fair and equitable access to health care and to employment based on clinical need and merit. This has advantages for staff by allowing them to give of their best and for patients by better identifying and meeting their needs. Evidence shows that individuals from minority groups are often not treated fairly and positive action is required to redress the balance
Consultation computer use to improve management of chronic disease in general practice: a before and after study
Get PDFBackground Computers have become widespread in primary care but their potential to improve clinical effectiveness has not been completely fulfilled. One explanation for this is the difficulty in evaluating their impact on the process of care.
Aim To determine the effects of computers in consulting rooms on the management of chronic disease.
Methods Before and after study with concurrent control group, matching six practices moving from paper-based recording to a consultation-based computer environment, with six practices using paper-based systems. Data were collected retrospectively via case note review for the year preceding the arrival of the computers and for the subsequent year. All patients with diagnosed diabetes mellitus (n = 1070) or rheumatoid disease (n = 202) were included. The main outcome measure was recording of disease management items.
Results The computer group improved recording for seven of the eight diabetic and four of the seven rheumatoid items studied. Increases were significant for height (5% increase; 95% confidence interval (CI): 1.2% to 8.8%), weight (6.6%; 95% CI: 2.2% to 11.0%), foot pulses (8.7%; 95% CI: 4.1% to 13.4%), foot sensation (8.6%; 95% CI: 5.2% to 11.9%), blood pressure (12.6%; 95% CI: 2.0% to 23.2%) and urinalysis (20.2%; 95% CI: 11.0% to 29.4%). The control group improved for two diabetic and five rheumatoid items, the only significant increase being for urinalysis (1.1%; 95% CI: 0.2% to 22.0%). Computer use was associated with increased recording of each diabetes item except fundoscopy, and with increased blood pressure recording for rheumatoid disease. The larger the practice, the larger the effects observed.
Conclusions Use of computers can improve management of chronic disease in primary care. Impact is most clearly seen in those items easily recorded on computer during consultations. Effects are most evident in practices with larger patient numbers
An intelligent partner system for improving chronic illness care
Get PDFChronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS), which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care
The efficacy of an automated feedback system for general practitioners
Get PDFObjective An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs.
Design We used a randomised controlled trial with balanced block design.
Setting Five times six participant groups of GPs in a computer laboratory setting.
Intervention The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms.
Subjects Twenty-four randomly selected GPs participated.
Main outcome measures The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12_22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28_51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders.
Implications Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable
What does information about referrals reveal about the service network?
Get PDFObjective To identify the most important referring parties in the Finnish health care system.
Design A record linkage study based on nationwide administrative registers.
Setting The hospital discharge register during 1996 to 2000.
Subjects The total Finnish population and the population of four hospital districts.
Main outcome measures Discharges of individuals by the most important referring parties.
Results The five most important referring parties in order of magnitude are as follows: health centre, no referral, clinic/unit of the same hospital, hospital other than a health centre, and private health care. The five most important referring parties for those aged over 75 are the same mentioned above. There were regional differences in referral practices.
Conclusions Differences or changes in referral profiles as a function of time cannot be taken as a direct measure of the impact of possible interventions or as an indication of an actual difference between the areas compared. One should also always be aware about any related metaknowledge
A survey of computer use in Scottish primary care: general practitioners are no longer technophobic but other primary care staff need better computer access
Get PDFObjective To describe the use of computing systems by primary care staff in Scotland.
Participants Practice managers in Scotland on behalf of their practice teams.
Methods A survey of computer use in Scottish general practices was carried out by the Scottish Clinical Information Management in Primary Care (SCIMP) group in April 2001. Every practice was sent an electronic copy of a questionnaire using NHSnet. Practices that did not respond to the electronic version were sent a paper version of the questionnaire.
Main outcome measures Access to computers, use during consultations, links to laboratories, problems experienced by users.
Results A total of 308 practices (30%) replied to the electronic questionnaire and 346 practices (33%) to a paper version, giving an overall response rate of 63% (654 practices). A total of 296 (29%) of practices could not receive the electronic version. It was reported that 94% of general practitioners and 74% of practice nurses frequently used a computer; 72% of practices used their computer for chronic disease management. There was great variability in links to laboratories for lab results (range 1_30% by region). Of responding practices, 16% had plans for a unified patient record, but access to a computer is still a major problem for community nurses. Satisfaction was expressed for all systems and many practices also use third-party programs.
Conclusions Most Scottish doctors make frequent use of computers for a variety of clinical and practice management activities. Many other staff want to make greater use of computers, but are often unable to obtain access
Moving toward a United States strategic plan in primary care informatics: a White Paper of the Primary Care Informatics Working Group, American Medical Informatics Association
Get PDFThe Primary Care Informatics Working Group (PCIWG) of the American Medical Informatics Association (AMIA) has identified the absence of a national strategy for primary care informatics. Under PCIWG leadership, major national and international societies have come together to create the National Alliance for Primary Care Informatics (NAPCI), to promote a connection between the informatics community and the organisations that support primary care. The PCIWG clinical practice subcommittee has recognised the necessity of a global needs assessment, and proposed work in point-of-care technology, clinical vocabularies, and ambulatory electronic medical record development. Educational needs include a consensus statement on informatics competencies, recommendations for curriculum and teaching methods, and methodologies to evaluate their effectiveness. The research subcommittee seeks to define a primary care informatics research agenda, and to support and disseminate informatics research throughout the primary care community. The AMIA board of directors has enthusiastically endorsed the conceptual basis for this White Paper