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Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

ABSTRACT: BACKGROUND:One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient's medication and its usage. E-prescribing has become increasingly applied in recent years as a contributing application to prescribers and patients. The aim of this study was to determine the level of satisfaction of family physicians providing primary care in Turkey regarding the application of e-prescriptions, and reveal the related positive effects and problems encountered in the first months of implementation of e-prescribing. METHODS:A questionnaire with eight questions was sent to e-mails of all family physicians working in Turkey in May 2013. A total of 1564 family physicians filled in the questionnaire form and sent it back by e-mail. The responses to openended questions were evaluated by content analysis. RESULTS:It was observed that the most frequently indicated advantages of the application of e-prescriptions were speeding up the prescription process and saving time (36.6%). The most commonly reported problems regarding the application of e-prescriptions were found to be system-induced problems (26.5%) and internet problems (19.9%). In addition, the mean score of satisfaction of the family physicians who did not report problems with the application of e-prescriptions was higher than that of those who reported having problems with it. In the study, 77.8% of the family physicians were satisfied with the application of e-prescriptions. CONCLUSION:Although some problems were reported regarding the application of e-prescriptions in the first months of the application, family physicians participated in the study were found to be satisfied with the application of e-prescriptions, and identified positive effects on their work and processes.

SUBMITTER: Bulut S

PROVIDER: S-EPMC6358642 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

Bulut Sinan S Yıldız Ahmet A Kaya Sıdıka S

International journal of health policy and management 20190101 1

<h4>Background</h4>One of the most important steps of the health transformation program involves the application of electronic prescriptions (e-prescriptions) in health services. Information technologies are highly important in generating e-prescriptions, which can be described as a document produced by authorized personnel electronically, containing written information and instructions regarding a patient's medication and its usage. E-prescribing has become increasingly applied in recent years ...[more]

PMID: 30709101

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Project description:BackgroundAs a result of demographic changes, physicians are required to deliver needed services with limited resources. Research suggests that tablet PCs with access to patient data may streamline clinical workflow. A recent study found tablets with mobile electronic medical records (EMRs) can facilitate data retrieval and produce time savings across the clinical routine within hospital settings. However, the reasons for these time savings, including details on how tablets were being used, remain unclear. The same applies to physicians' perceptions of this tool within an inpatient setting.ObjectiveThis study examined physicians' perception of tablets with EMRs in an inpatient setting. The rationale was to identify both subjective and objective factors that impacted the successful implementation and use of tablets running an EMR.MethodsWe developed a 57-item survey questionnaire designed to examine users' perception of and attitude toward tablets, which was administered to 14 participating physicians following 7 weeks of tablet use. Five participants volunteered to participate in a second study that investigated physicians' patterns of tablet use within the EMR environment by digitally tracking and storing usage behavior. Statistical analyses of questionnaire results included mean values with their bootstrapped 95% confidence intervals and multivariate analysis of variance to identify predictors of tablet use.ResultsPhysicians reported high degrees of satisfaction with the tablets. There was a general consensus among physicians that tablet use streamlined clinical workflow through optimized data retrieval (rated 0.69, 0.23-1.15 points better than control) and improved communication with patients and other physicians (rated 0.85, 0.54-1.15 and 0.77, 0.38-1.15 points better than control, respectively). Age (F3,11=3.54, P=.04), occupational group (F1,11=7.17, P=.04), and attitude toward novel technologies (F1,11=10.54, P=.02) predicted physicians' satisfaction with the devices and their motivation regarding their further use. Tracking data yielded that only a few of the available functions were used frequently.ConclusionsAlthough tablet PCs were consistently perceived as beneficial, several factors contributed to the fact that their full potential was not fully exploited. Training in functionality and providing a reliable infrastructure might foster successful tablet implementation.

Project description:ImportancePrimary care physicians (PCPs) report multitasking during workdays while processing electronic inbox messages, but scant systematic information exists on attention switching and its correlates in the health care setting.ObjectivesTo describe PCPs' frequency of attention switching associated with electronic inbox work, identify potentially modifiable factors associated with attention switching and inbox work duration, and compare the relative association of attention switching and other factors with inbox work duration.Design, setting, and participantsThis cross-sectional study of the work of 1275 PCPs in an integrated group serving 4.5 million patients used electronic health record (EHR) access logs from March 1 to 31, 2018, to evaluate PCPs' frequency of attention switching. Statistical analysis was performed from October 15, 2018, to August 28, 2020.Main outcomes and measuresAttention switching was defined as switching between the electronic inbox, other EHR work, and non-EHR periods. Inbox work duration included minutes spent on electronic inbox message views and related EHR tasks. Multivariable models controlled for the exposures.ResultsThe 1275 PCPs studied (721 women [56.5%]; mean [SD] age, 45.9 [8.5] years) had a mean (SD) of 9.0 (7.6) years of experience with the medical group and received a mean (SD) of 332.6 (148.3) (interquartile range, 252-418) new inbox messages weekly. On workdays, PCPs made a mean (SD) of 79.4 (21.8) attention switches associated with inbox work and did a mean (SD) 64.2 (18.7) minutes of inbox work over the course of 24 hours on workdays. In the model for attention switching, each additional patient secure message beyond the reference value was associated with 0.289 (95% CI, 0.217-0.362) additional switches, each additional results message was associated with 0.203 (95% CI, 0.127-0.278) additional switches, each additional request message was associated with 0.190 (95% CI, 0.124-0.257) additional switches, and each additional administrative message was associated with 0.262 (95% CI, 0.166-0.358) additional switches. Having a panel (a list of patients assigned to a primary care team) with more elderly patients (0.144 switches per percentage increase [95% CI, 0.009-0.278]) and higher inbox work duration (0.468 switches per additional minute of inbox work [95% CI, 0.411-0.524]) were also associated with higher attention switching involving the inbox. In the model for inbox work duration, each additional patient secure message beyond the reference value was associated with 0.151 (95% CI, 0.085-0.217) additional minutes, each additional results message was associated with 0.338 (95% CI, 0.272-0.404) additional minutes, each additional request message was associated with 0.101 (95% CI, 0.041-0.161) additional minutes, and each additional administrative message was associated with 0.179 (95% CI, 0.093-0.265) additional minutes. A higher percentage of the panel's patients initiating messages (0.386 minutes per percentage increase [95% CI, 0.026-0.745]) and attention switches (0.373 minutes per switch [95% CI, 0.328-0.419]) were also associated with higher inbox work duration. In addition, working at a medical center where all PCPs had high inbox work duration was independently associated with high or low inbox work duration.Conclusions and relevanceThis study suggests that PCPs make frequent attention switches during workdays while processing electronic inbox messages. Message quantity was associated with both attention switching and inbox work duration. Physician and patient panel characteristics had less association with attention switching and inbox work duration. Assisting PCPs with message quantity might help modulate both attention switching and inbox work duration.

Project description:BackgroundElectronic information exchange is believed to improve efficiency and reduce resource utilization. We developed a Web-based standardized communication system (SCS) that enables family physicians to receive detailed reports of their patients' care in the emergency department. We sought to determine the impact of the SCS on measures of resource utilization in the emergency department and family physician offices.MethodsWe used an open 4-period crossover cluster-randomized controlled design. During 2 separate 10-week intervention phases, family physicians received detailed reports of their patients' emergency department visits over the Internet, and in the alternating control phases they received a 1-page copy of the emergency department notes by mail. The primary outcome was the number of repeat visits to the emergency department within 14 days of the initial visit. Secondary outcomes included duplication of test and specialty consultation requests by the emergency and family physician. Outcomes were measured using the hospital database and questionnaires sent to the family physicians.ResultsA total of 2022 patient visits to the emergency department from 23 practices were used in the study. Use of the SCS failed to reduce the number of repeat visits to the emergency department within 14 days (odds ratio [OR] 1.10, 95% confidence interval [CI] 0.8-1.51) and 28 days (OR 1.01, 95% CI 0.8-1.27). There was no significant duplication of requests for diagnostic tests between the emergency and family physician during the intervention and control phases (24 v. 22, p = 0.93), but there was significantly greater duplication in specialty consultation requests in the intervention phase than in the control phase (20 v. 8, p = 0.049).InterpretationAn electronic link between emergency and family physicians did not result in a significant reduction in resource utilization at either service point. Investments in improved electronic information exchange between emergency departments and family physician offices may not be substantiated by a reduction in resource utilization.

Project description:Adults are at substantial risk for vaccine-preventable disease, but their vaccination rates remain low.To assess practices for assessing vaccination status and stocking recommended vaccines, barriers to vaccination, characteristics associated with reporting financial barriers to delivering vaccines, and practices regarding vaccination by alternate vaccinators.Mail and Internet-based survey.Survey conducted from March to June 2012.General internists and family physicians throughout the United States.A financial barriers scale was created. Multivariable linear modeling for each specialty was performed to assess associations between a financial barrier score and physician and practice characteristics.Response rates were 79% (352 of 443) for general internists and 62% (255 of 409) for family physicians. Twenty-nine percent of general internists and 32% of family physicians reported assessing vaccination status at every visit. A minority used immunization information systems (8% and 36%, respectively). Almost all respondents reported assessing need for and stocking seasonal influenza; pneumococcal; tetanus and diphtheria; and tetanus, diphtheria, and acellular pertussis vaccines. However, fewer assessed and stocked other recommended vaccines. The most commonly reported barriers were financial. Characteristics significantly associated with reporting greater financial barriers included private practice setting, fewer than 5 providers in the practice, and, for general internists only, having more patients with Medicare Part D. The most commonly reported reasons for referring patients elsewhere included lack of insurance coverage for the vaccine (55% for general internists and 62% for family physicians) or inadequate reimbursement (36% and 41%, respectively). Patients were most often referred to pharmacies/retail stores and public health departments.Surveyed physicians may not be representative of all physicians.Improving adult vaccination delivery will require increased use of evidence-based methods for vaccination delivery and concerted efforts to resolve financial barriers, especially for smaller practices and for general internists who see more patients with Medicare Part D.Centers for Disease Control and Prevention.

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Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

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Evaluation of Transition to Electronic Prescriptions in Turkey: Perspective of Family Physicians.

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