Users’ satisfaction with the primary health care information system in Croatia: a cross-sectional study

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Abstract

Aim

To evaluate the primary health care information system from the general practitioner's (GP) point of view.

Methods

Sixty-seven Croatian GPs were distributed a questionnaire about characteristics of the GP’s office, overall impression of the application, handling of daily routine information, more sophisticated information needs, and data security, and rated their satisfaction with each component from 1 to 5. We also compared two most frequently used applications – application with distantly installed software (DIS) and that with locally installed software (LIS, personal computer-based application).

Results

GPs were most satisfied with the daily procedures and the reminder component of the health information system (rating 4.1). The overall impression ranked second (3.5) and flexibility of applications followed closely (3.4). The most questionable aspect of applications was data security (3.0). LIS system received better overall rate than DIS (4.2 vs 3.2).

Conclusion

Applications received better ratings for daily routine use than for overall impression and ability to get specific information according the GPs’ needs. Poor ratings on the capability of the application, complaints about unreliable links, and doubts about data security point to a need for more user-friendly interfaces, more information on the capability of the application, and a valid certificate of assessment for every application.

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Most cited references 39

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The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care.

Robyn Tamblyn, Peter McLeod, Allen Huang … (2003)

Adverse drug-related events are common in the elderly, and inappropriate prescribing is a preventable risk factor. Our objective was to determine whether inappropriate prescribing could be reduced when primary care physicians had computer-based access to information on all prescriptions dispensed and automated alerts for potential prescribing problems. We randomly assigned 107 primary care physicians with at least 100 patients aged 66 years and older (total 12 560) to a group receiving computerized decision-making support (CDS) or a control group. Physicians in the CDS group had access to information on current and past prescriptions through a dedicated computer link to the provincial seniors' drug-insurance program. When any of 159 clinically relevant prescribing problems were identified by the CDS software, the physician received an alert that identified the nature of the problem, possible consequences and alternative therapy. The rate of initiation and discontinuation of potentially inappropriate prescriptions was assessed over a 13-month period. In the 2 months before the study, 31.8% of the patients in the CDS group and 33.3% of those in the control group had at least 1 potentially inappropriate prescription. During the study the number of new potentially inappropriate prescriptions per 1000 visits was significantly lower (18%) in the CDS group than in the control group (relative rate [RR] 0.82, 95% confidence interval [CI] 0.69-0.98), but differences between the groups in the rate of discontinuation of potentially inappropriate prescriptions were significant only for therapeutic duplication by the study physician and another physician (RR 1.66, 95% CI 0.99-2.79) and drug interactions caused by prescriptions written by the study physician (RR 2.15, 95% CI 0.98-4.70). Computer-based access to complete drug profiles and alerts about potential prescribing problems reduces the rate of initiation of potentially inappropriate prescriptions but has a more selective effect on the discontinuation of such prescriptions.

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Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters.

Shmuel Reis, Mary Dunevant, Susan Larson … (2006)

Within the context of medical care there is no greater reflection of the information revolution than the electronic medical record (EMR). Current estimates suggest that EMR use by Israeli physicians is now so high as to represent an almost fully immersed environment. This study examines the relationships between the extent of electronic medical record use and physician-patient communication within the context of Israeli primary care. Based on videotapes of 3 Israeli primary care physicians and 30 of their patients, the extent of computer use was measured as number of seconds gazing at the computer screen and 3 levels of active keyboarding. Communication dynamics were analyzed through the application of a new Hebrew translation and adaptation of the Roter Interaction Analysis System (RIAS). Physicians spent close to one-quarter of visit time gazing at the computer screen, and in some cases as much as 42%; heavy keyboarding throughout the visit was evident in 24% of studied visits. Screen gaze and levels of keyboarding were both positively correlated with length of visit (r = .51, p < .001 and F(2,27) = 2.83, p < .08, respectively); however, keyboarding was inversely related to the amount of visit dialogue contributed by the physician (F(2,27) = 4.22, p < .02) or the patient (F(2,27) = 3.85, p < .05). Specific effects of screen gaze were inhibition of physician engagement in psychosocial question asking (r = -.39, p < .02) and emotional responsiveness (r = -.30, p < .10), while keyboarding increased biomedical exchange, including more questions about therapeutic regimen (F(2,27) = 4.78, p < .02) and more patient education and counseling (F(2,27) = 10.38, p < .001), as well as increased patient disclosure of medical information to the physician (F(2,27) =3.40, p < .05). A summary score reflecting overall patient-centered communication during the visit was negatively correlated with both screen gaze and keyboarding (r = -.33, p < .08 and F(2,27) = 3.19, p < .06, respectively). The computer has become a 'party' in the visit that demanded a significant portion of visit time. Gazing at the monitor was inversely related to physician engagement in psychosocial questioning and emotional responsiveness and to patient limited socio-emotional and psychosocial exchange during the visit. Keyboarding activity was inversely related to both physician and patient contribution to the medical dialogue. Patients may regard physicians' engrossment in the tasks of computing as disinterested or disengaged. Increase in visit length associated with EMR use may be attributed to keyboarding and computer gazing. This study suggests that the way in which physicians use computers in the examination room can negatively affect patient-centered practice by diminishing dialogue, particularly in the psychosocial and emotional realm. Screen gaze appears particularly disruptive to psychosocial inquiry and emotional responsiveness, suggesting that visual attentiveness to the monitor rather than eye contact with the patient may inhibit sensitive or full patient disclosure. We believe that training can help physicians optimize interpersonal and educationally effective use of the EMR. This training can assist physicians in overcoming the interpersonal distancing, both verbally and non-verbally, with which computer use is associated. Collaborative reading of the EMR can contribute to improved quality of care, enhance the decision-making process, and empower patients to participate in their own care.

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A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease.

Thomas D. Sequist, Tejal Gandhi, Andrew Karson … (2015)

The aim of this study was to evaluate the impact of an integrated patient-specific electronic clinical reminder system on diabetes and coronary artery disease (CAD) care and to assess physician attitudes toward this reminder system. We enrolled 194 primary care physicians caring for 4549 patients with diabetes and 2199 patients with CAD at 20 ambulatory clinics. Clinics were randomized so that physicians received either evidence-based electronic reminders within their patients' electronic medical record or usual care. There were five reminders for diabetes care and four reminders for CAD care. The primary outcome was receipt of recommended care for diabetes and CAD. We created a summary outcome to assess the odds of increased compliance with overall diabetes care (based on five measures) and overall CAD care (based on four measures). We surveyed physicians to assess attitudes toward the reminder system. Baseline adherence rates to all quality measures were low. While electronic reminders increased the odds of recommended diabetes care (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.01-1.67) and CAD (OR 1.25, 95% CI 1.01-1.55), the impact of individual reminders was variable. A total of three of nine reminders effectively increased rates of recommended care for diabetes or CAD. The majority of physicians (76%) thought that reminders improved quality of care. An integrated electronic reminder system resulted in variable improvement in care for diabetes and CAD. These improvements were often limited and quality gaps persist.

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Author and article information

Journal

Journal ID (nlm-ta): Croat Med J

Journal ID (publisher-id): CMJ

Title: Croatian Medical Journal

Publisher: Croatian Medical Schools

ISSN (Print): 0353-9504

ISSN (Electronic): 1332-8166

Publication date (Print): February 2012

Volume: 53

Issue: 1

Pages: 60-65

Affiliations

[1]Department of Medical Informatics, University of Zagreb, School of Medicine, Zagreb, Croatia

Author notes

Correspondence to:  Lidija Andrijašević University of Zagreb School of Medicine Šalata 3 10000 Zagreb, Croatia  lidija.andrijasevic@ 123456gmail.hr

Article

Publisher ID: CroatMedJ_53_0060

DOI: 10.3325/cmj.2012.53.60

PMC ID: 3284175

PubMed ID: 22351580

SO-VID: c087740e-9efd-4e6a-970b-217df5660cdf

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Users’ satisfaction with the primary health care information system in Croatia: a cross-sectional study

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Abstract

Aim

Methods

Results

Conclusion

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JMIR Publications

Most cited references 39

The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care.

Electronic medical record use and physician-patient communication: an observational study of Israeli primary care encounters.

A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease.

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