[Qualitative approach to the attitudes and expectations of doctors during the process of computerising primary care]

[Not Available]

OBJECTIVE

To find out patients' opinions of e-medicine, obtaining general ideas related to three relevant aspects: electronic health records (EHR), the web as an information source and use of e-mail.

DESIGN

Qualitative phenomenological study, analysing the content of group interviews. Content analysis was performed by the three researchers.

PARTICIPANTS

Urban patients. Internet and e-mail practical knowledge.

VARIABLES

age and gender, districts with different socio-economic levels.

SETTING

San Sebastián (Spain).

RESULTS

Four focal groups, with 35 people, 12 under 25 years old, 10 over 65, and 16 women. EHR valuation was very positive. Computer use does not change the health worker-patient relationship. It must spread to the home setting, and be available from any point, creating another kind of relationship, regardless of the distance. Single EHR for all the suppliers. Patients consider themselves authorised to manipulate it. Participants use the web as an information source, looking for safe sources and specific information, and to verify health workers information. The relationship with doctors is irreplaceable. E-mail is a useful alternative for specific needs. It would force a redesign of working schedule and to define the conditions of use.

CONCLUSIONS

New technologies are widely used. Acceptance is practically unanimous. Ideas such as continuous care by the same person are very innovative. It seems that we are faced with a powerful technology, which could improve and facilitate patient care, as patient awareness of their individual rights coincides with unlimited access to the information.

[Changes in physicians' attitudes to computerized ambulatory medical record systems: a longitudinal qualitative study]

OBJECTIVES

To explore physicians' beliefs about a computerized ambulatory medical record system at different stages of its implementation.

METHODS

We performed a longitudinal qualitative in-depth interview study (July 2001 to December 2003) in the Hospital Italiano, Buenos Aires, Argentina. Semi-structured interviews were conducted in 20 primary care cardiologists purposively selected before, during and after the system's implementation process (10 interviews per stage). The interviews were independently analyzed by 2 researchers, who jointly designed an agreed category list.

RESULTS

Both before and during the first stage of the implementation process, the physicians expected that that the system would improve healthcare-related administration and increase accessibility to individual data. However, they did not foresee that the system's shared information could modify the clinical aspects of patient care. By the end of the implementation process, the physicians realized that the system provided them with a broader perspective on their patients, which in turn improved their own professional performance. Throughout the implementation, the physicians were against using the computer while the patient was present. This opposition prevented them from regarding the system as part of the medical consultation and from considering data from the system as direct patient-related signs.

CONCLUSIONS

The system's implementation modified the physicians' views on computerized ambulatory medical records, as they eventually considered them as an ancillary tool to clinical activity. The value assigned to the system depends on its relevance within the institutional framework.

[Views of professionals and patients on the introduction of computer science into the consultation]

OBJECTIVE

To compare the views of professionals and patients on the computerisation of consultations.

DESIGN

Cross-sectional.

SETTING

Rural health district in the province of Barcelona, with a population of about 15,000.

PARTICIPANTS

Consecutive sampling of people seen in the health district and the group of health professionals working in it.

MAIN MEASUREMENTS

Two anonymous self-filled questionnaires with closed questions aimed at health professionals and a sample of patients (accuracy, 0.05; confidence, 95%; prevalence, 50%).

RESULTS

The mean age of the 407 patients was 48.4 (SD, 17.2), with 63.6% women. 21 questionnaires were filled in by the professionals (91%), 12 by doctors, and 9 by nurses. Their mean age was 43.9 (SD, 7.5), and 71.4% were women. For common questions, 54.3% of patients were keen on seeing the screen, while professionals calculated this figure at 11%. 5.6% of patients thought computerisation had changed the relationship, whereas 31.6% of professionals did. 12.6% of patients thought it had made the visit longer, whereas 38.1% of the professionals thought it had. 10.6% of patients and 47.4% of professionals thought it had led to loss of confidentiality.

CONCLUSIONS

The introduction of computers into consultations was accepted well. Professionals were more worried than patients about possible loss of confidentiality, and thought that there had been bigger changes in the doctor-patient relationship and that visits had become longer.