Weddle T, Johnson K; AcademyHealth. Meeting (2004 : San Diego, Calif.).
Abstr AcademyHealth Meet. 2004; 21: abstract no. 2027.
Loyola University Chicago, Sociology, 6525 N. Sheridan Road - DH 9th Floor, Chicago, IL 60626 Tel. 312.208.0533 Fax 773.508.7099
RESEARCH OBJECTIVE: Computer use by physicians has long been identified as a major potential contributor to improved medical care quality. While there is mounting evidence that increased computer use improves medical quality, few physicians actually utilize computers to their full potential. This study looks for factors within the social environment of physicians medical practice that systematically produce and reproduce the gap between desired and actual physician information system usage. The study focuses on rural primary care physicians (PCPs) who practice in a variety of practice sizes and are removed from the pressures of using computers in response to managed care. STUDY DESIGN: Experiences and opinions about computer use were obtained from a target population of primary care physicians in 20 mid-west rural counties using a two-stage data collection design. The first stage involved semi-structured interviews of approximately 45-minutes with PCPs in 5 counties. The interview transcriptions were analyzed to identify common patterns. The interview participation rate was 33%. The second data collection stage consisted of a mail survey to PCPs in 15 additional rural counties. The mail survey responses were analyzed using simple tabulation. Factor analysis was used to identify groupings of responses. The survey response rate was 67%. POPULATION STUDIED: The target population consisted of primary care physicians (family medicine, general practice, internal medicine, pediatrics, and OB/GYNE) who practice in 20 mid-west rural counties. PRINCIPAL FINDINGS: Most physicians reported using a computer to retrieve information, but with the exception of writing email to other physicians, only a very small minority of physicians entered patient-related information. Physicians in small groups see a greater need then physicians in large groups to improve their use of computers. Physicians with 10 to 20 years of experience see less of a need for improved computer use than younger or older physicians. The single most influential social factor in computer use was clarity of the social meaning of the computer within a particular medical practices setting. CONCLUSIONS: Rural PCPs are not resistant to computers per se but rather they are resistant to technology that takes them out of their routines. These findings indicate that the barriers to improved computer use, and improved medical quality, are largely social rather than individual. The development of physician computer technology, the use of computers by physicians, and the definition of what it means to be a physician vacillate within a struggle to clarify the social meaning of computers in medicine. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The results of the study are of interest to policy makers, providers and organizations interested in quality of care issues, and to organizations involved in the implementation of physician computer systems. For instance, national policies may be needed to assure that the definition of being a physician includes at least a minimum requirement to provide patient information via computer, while protecting physicians from being required to overuse computers. Or, for instance, special strategies may be needed to protect small physician practices from information system mandates that disproportionately disadvantage them vis--vis larger group practices.
Publication Types:
Keywords:
- Attitude to Computers
- Child
- Computers
- Data Collection
- Family Practice
- Health Services Needs and Demand
- Humans
- Information Systems
- Internal Medicine
- Managed Care Programs
- Physicians
- Physicians, Family
- Social Environment
- Software
- economics
- utilization
- hsrmtgs
UI: 103625061
From Meeting Abstracts