Informatics in Primary Care

BACKGROUND: The benefit of self-monitoring of blood glucose by patients has been questioned, and UK policy is generally not to support this, although it is identified that there may be unidentified subgroups of people who would benefit from being supported to self-monitor. The purpose of this paper is to explore the self-management approaches of people with diabetes, and how self-testing of blood glucose contributes to self-management strategies. METHODS: This qualitative study of patients' experiences drew data from contributors to online discussion boards for people living with diabetes...

This journal strongly supports the sharing of data to support research and quality improvement. However, this needs to be done in a way that ensures the benefits vastly outweigh the risks, and vitally using methods which are inspire both public and professional confidences--robust pseudonymisation is needed to achieve this. The case for using routine data for research has already been well made and probably also for quality improvement; however, clearer mechanisms are needed of how we test that the public interest is served...

BACKGROUND: In medication therapy management there is a need for a tool to document medication reviews and pharmaceutical care plans (PCPs) as well as facilitate collaboration and sharing of patient data between different healthcare providers. Currently, pharmacists and general practitioners (GPs) have their own computer systems and patient files. To facilitate collaboration between different healthcare providers and to exchange patient data we developed a paper-based tool. As a result the structured collection of all relevant information for a clinical medication review was more protocol driven...

BACKGROUND: This paper explores the scope of malaria-susceptibility modelling to predict malaria occurrence in an area. OBJECTIVE: An attempt has been made in Varanasi district, India, to evaluate the status of malaria disease and to develop a model by which malaria-prone zones could be predicted using five classes of relative malaria susceptibility, i.e.very low, low, moderate, high and very high categories. The information value (Info Val) method was used to assess malaria occurrence and various time-were used as the independent variables...

No abstract text is available yet for this article.

BACKGROUND: High levels of funding have been invested in health information technologies, especially electronic health records (EHRs), in an effect to coordinate and organize patient health data. However, the effect of EHRs in the exam room on doctor-patient communication has not been sufficiently explored. Objective The purpose of this systematic review was to determine how physician use of EHRs in medical consultations affects doctor-patient communication, both in terms of patient perceptions and actual physician behaviours...

BACKGROUND: The effect of health information technology (HIT) on efficiency and workload among clinical and nonclinical staff has been debated, with conflicting evidence about whether electronic health records (EHRs) increase or decrease effort. None of this paper to date, however, examines the effect of interoperability quantitatively using discrete event simulation techniques. OBJECTIVE: To estimate the impact of EHR systems with various levels of interoperability on day-to-day tasks and operations of ambulatory physician offices...

OBJECTIVE: To evaluate the association between electronic health record (EHR) satisfaction and job satisfaction in primary care physicians (PCPs). METHOD: Cross-sectional survey of PCPs at 825 primary care practices in North Carolina. RESULTS: Surveys were returned from 283 individuals across 214 practices (26% response rate for practices), of whom 122 were physicians with EHRs and no missing information. We found that for each point increase in EHR satisfaction, job satisfaction increased by ∼0...

This paper reports on a head-to-head study of howRU and EQ-5D on patients with cardiovascular disease. howRU is a short generic measure of health-related quality of life comprising 39 words, designed for routine use, which we compare with EQ-5D (230 words). Patients attending a clinic completed both instruments. Completed data were available for 116 patients, 51% female, mean age 56 and SD 20. howRU is shorter, has better readability statistics, a higher completion rate, a wider range of states used and a smaller ceiling effect than EQ-5D...

Job satisfaction in primary care is associated with getting on with your computer. Many primary care professionals spend longer interacting with their computer than anything else in their day. However, the computer often makes demands rather than be an aid or supporter that has learned its user's preferences. The use of electronic patient record (EPR) systems is underrepresented in the assessment of entrants to primary care, and in definitions of the core competencies of a family physician/general practitioner...

BACKGROUND: General practitioners (GPs) are increasingly pressured to prescribe cost-effectively, due to rising prescribing expenditure and limited budgets. A computerised prescribing substitution application (ScriptSwitch(®)) provides 'pop-ups' of cost-saving drug switches at the point of prescribing. It has been used by some United Kingdom local health commissioning organisations as part of a medicines management strategy. OBJECTIVE: To explore GPs' views on using this prescribing substitution application in their day-to-day clinical practice...

BACKGROUND: The system informs the nurse about levels of physical activity in the daily living of patients who are using the It's LiFe! tool. The tool consists of an accelerometer that transfers data to a smartphone, which is subsequently connected to a server. Nurses can monitor patients' physical activity via a secured website. Physical activity levels are measured in minutes per day compared with pre-set activity goals, which are set in dialogue with the patient. OBJECTIVE: To examine user requirements and to evaluate the usability of the secured website, in order to increase the probability of effective use by nurses...

BACKGROUND: Demand is increasing for primary care to deliver effective weight management services to patients, but research suggests that staff feel inadequately resourced for such a role. Supporting service delivery with a free and effective web-based weight management programme could maximise primary care resource and provide cost-effective support for patients. However, integration of e-health into primary care may face challenges. OBJECTIVES: To explore primary care staff experiences of delivering weight management services and their perceptions of a web-based weight management programme to aid service delivery...

BACKGROUND: Innovators have piloted improvements in communication, changed patterns of practice and patient empowerment from online access to electronic health records (EHR). International studies of online services, such as prescription ordering, online appointment booking and secure communications with primary care, show good uptake of email consultations, accessing test results and booking appointments; when technologies and business process are in place. Online access and transactional services are due to be rolled out across England by 2015; this review seeks to explore the impact of online access to health records and other online services on the quality and safety of primary health care...

BACKGROUND: Telehealth has been promoted as an adjunct to managing patients with long-term conditions. It has been used in various settings and for different disease groups. However, robust evidence for the efficacy of telehealth is currently lacking. OBJECTIVES: To evaluate the impact of a telehealth service on emergency admissions and emergency department (ED) attendances. METHODS: We evaluated a telehealth service providing supported self-management to patients that was implemented in Nottingham City...

BACKGROUND: Adverse drug events may occur as a result of drug-drug interactions (DDIs). Information technology (IT) systems can be an important decision-making tool for healthcare workers to identify DDIs. OBJECTIVE: The aim of the study is to analyse drug prescriptions in our main hospital units, in order to measure the incidence and severity of potential DDIs. The utility of clinical decision-support systems (CDSSs) and computerised physician order entry (CPOE) in term of alerts adherence was also assessed...

BACKGROUND: The trend towards hospitalist medicine can lead to disjointed patient care. Outpatient clinicians may be unaware of patients' encounters with a disparate healthcare system. Electronic notifications to outpatient clinicians of patients' emergency department (ED) visits and inpatient admissions and discharges using health information exchange can inform outpatient clinicians of patients' hospital-based events. OBJECTIVE: Assess outpatient clinicians' impressions of a new, secure messaging-based, patient event notification system...

BACKGROUND: UK primary care physicians receive their laboratory test results electronically. This study reports a computerised physician order entry (CPOE) system error in the pathology test request date that went unnoticed in family practices. METHOD: We conducted a case study using a causation of risk theoretical framework; comprising interviews with clinicians and the manufacturer to explore the identification of and reaction to the error. The primary outcome was the evolution and recognition of and response to the problem...

BACKGROUND: Major initiatives are underway in Canada which are designed to increase electronic medical record (EMR) implementation and maximise its use in primary health care. These developments need to be supported by sufficient evidence from the literature, particularly relevant research conducted in the Canadian context. OBJECTIVES: This study sought to quantify this lack of research by: (1) identifying and describing the primary health care EMR literature; and (2) comparing the Canadian and international primary healthcare EMR literature on the basis of content and publication levels...

INTRODUCTION: Health research using routinely collected National Health Service (NHS) data derived from electronic health records (EHRs) and health service information systems has been growing in both importance and quantity. Wide population coverage and detailed patient-level information allow this data to be applied to a variety of research questions. However, the sensitivity, complexity and scale of such data also hamper researchers from fully exploiting this potential. OBJECTIVE: Here, we establish the current challenges preventing researchers from making optimal use of the data sets at their disposal, on both the legislative and practical levels, and give recommendations as to how these challenges can be overcome...