Effects of using a computer in a doctor's office on patient attitudes toward using computerized prompts in routine care

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Summary

Background:

We undertook this investigation to understand the effect of using a computer in a primary care setting on attitudes toward using computers to improve health services delivery.

Methods:

In this analysis, we compared the acceptability data from the group of primary care patients from 10 community-based practices who did not use a computer program, and answered the questions hypothetically, with data from a group of patients who actually used a program such as one proposed in the survey taken by the first group of patients. Attitudes toward three uses of the program, screening, counseling and changing treatments were measured, as well as attitudes toward specific aspects of the program, such as security.

Results:

The great majority of patients who used the program believed that the program was not too long (80.1%), was easy to use (82.3%) and that the questions were not hard to answer (75.7%). Also, on average only 20% of patients had concerns about the privacy and confidentiality of using the program. Patients who had used the computer program were significantly less likely to favor its use for screening [odds ratio (OR) = 0.09, 95% confidence interval (CI) = 0.04–0.19], counseling [OR = 0.13 (95% CI = 0.05–0.31)] and changing treatments for chronic conditions, such as hypertension [OR = 0.12 (95% CI = 0.07–0.23)]. Patients who felt that the computer took too long to use were less likely to favor its use for each of the three uses.

Conclusions:

Despite acceptability ratings that were high and consistent with ratings observed in other studies, exposure to the program significantly diminished support for using it in routine care. These findings highlight the need for measuring overall program acceptability in the context of a realistic use scenario and for correlating overall acceptability with acceptability of individual program components and attitudes, as a means for identifying opportunities for program improvement.

Section snippets

Background

Improving health care quality remains an elusive goal. Many investigators have shown that reminders, at the point of care, are an effective way to improve the quality of outpatient care [1], [2], [3]. What has not materialized, however, is a way to effectively to disseminate these reminders in routine outpatient scare, where electronic medical records are still rarely used [4]. Two main limitations of electronic medical record systems (EMR) is that: (1) they require too much time entering data

Methods: overall

The overall design for this analysis is a pre-post design in which two separate samples of individuals were surveyed. The first group of patients did not use a computer program, where the second group of patients completed the survey after having used a computer intervention. The intervention was a stand-alone computer application developed to provide tailored, printed feedback for primary care patients about two of the most common adverse health behaviors seen in primary care, smoking and

Methods: subjects

Primary care providers were recruited using letters sent to a random sample of 120 primary care providers and to physicians practicing in low-income public health clinics in Rhode Island. Ten community-based primary care providers responded to the letters and were recruited for the project. Of the physicians, six worked in solo or dual-physician practices and four worked in low-income public health clinics staffed by at least three primary care providers. The providers were of varied primary

Methods: measures

Measure development was informed by a series of focus groups with patients, which are described in detail elsewhere [11], [13]. We analyzed three survey items that reflected the interest of primary care patients in using computerized reminder systems. These items assessed patient attitudes toward the possible uses of computer technology to improve health care quality (‘to prompt your doctor to do health screening tests’, ‘to prompt your doctor to counsel you about your health behaviors’, and

Methods: analysis

Frequency distributions were performed to examine patient demographics, as well as determine the number of patients who visited the physician's office for either a routine exam or a specific complaint, the presence of a chronic condition, smoking status, levels of physical activity and past experience with the Internet. Next, patient characteristics were introduced in a series of multivariate logistic regressions to characterize their support for using a computer before each visit for prompting

Results

Table 1 presents the descriptive statistics of the study participants. There were no differences in key study characteristics between patients in the pre-computer and post-computer groups except for the purpose of the visit, where a greater proportion of participants in the pre-computer group were more likely to visit for a non-routine condition (68.4%) compared to those in the post-computer group (54.1%). Age was evenly distributed across cohorts. Similar to national estimates of the

Discussion

We set out in this study to understand the effects of experience with a computer program, designed to create personalized feedback for patients and personalized prompts for physicians, on patients’ attitudes toward using similar programs in routine care settings. We studied two separate groups of patients from the offices of 10 community-based primary care physicians. The first group was asked questions without having used such a computer program and the second group of patients had actually

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    Present address: Research Triangle Institute, NC, USA.

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