Chan WS et al. 2008 "Do general practitioners change how they use the computer during consultations with a significant psychological component?"
Reference
Chan WS, Stevenson M, McGlade K. Do general practitioners change how they use the computer during consultations with a significant psychological component? Int J Med Inf 2008;77(8):534-538.
Abstract
"Objectives: To describe the patterns of computer use during patient visits to family doctors and to determine whether doctors alter their pattern of computer use in consultations which have significant psychological content. Design: Observational, non-randomised cluster trial with data being collected from videotaped consultations. Setting: Three inner-city Family Practice offices involved in physician training in Belfast, Northern Ireland. Participants: Ten family doctors, who declared using computers during their consultations and consecutive consenting adult patients attending these doctors. Results: One hundred consultations were videotaped (59% patient participation rate). The average consultation time was 9 min 48 s, and number of problems per consultation was 1.9. Three broad styles of computer use were defined: (1) "endusers" who only used the computer at the end of a consultation to summarise the consultation, (2) "continuous users", who interacted with the computer throughout the consultation, and (3) "minimal users", who only ever used the computer at the end of the consultation mostly to issue prescriptions. Of the 100 consultations videoed 37% were of a psychological nature. Consultations with psychological content were on average longer (11 min 47 s vs. 8 min 39 s) and the average percentage time doctors spent on the computer was about half that of non-psychological consultations (11% vs. 23% and p < 0.001). Conclusion: The doctors were found to adopt one of three broad styles of computer use during their consultations. In consultations with observable significant psychological content doctors significantly reduce the proportion of time at the computer suggesting an ability to appropriately tailor their use of the computer during consultations."
Objective
To describe the patterns of computer use during patient visits to family doctors and to determine whether doctors alter their pattern of computer use in consultations that have significant psychological content.
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Large
Geography
Urban
Other Information
The study sites included, "[t]hree inner-city Family Practice offices involved in physician training in Belfast, Northern Ireland." The general practitioners were "from three training practices in a large health center."
Type of Health IT
Electronic health records (EHR)
Workflow-Related Findings
One physician was a minimal user of the system and mainly used it "for printing prescriptions at the end of the consultation." This GP also stated that the computer made no difference during the consultation in terms of usefulness. Three physicians "made consistent use of the computer throughout their consulations, either for reviewing notes, typing in patient's problems, typing letters and making prescriptions. The GPs using this consulting style often drew patients' attention to the computer bringing about a form of three-way interaction." Six physicians would use the computer "at the end of the consultation with the patient still in the consulting room...They tended to type of notes with the patient at hand before making out prescriptions with the computer."
In consultations with psychological content, "the mean percentage time spent on the computer was 11.9%...compared with 22%," a significant difference (p < .001). "Significantly less time was spent on the computer (82 s on average) in psychological consultations compared with non-psychological consultations (112 s on average)," (p = 0.041).
"Despite the computer being considered as a potentially harmful distraction, doctors are still able to not only pick up on psychological cues, but also are prepared to alter their consulting style and the way they use the computer in response."
"All of the GPs said they used the computer during the consultation, 9 said it was a very useful tool in the consultation with one GP saying it made no difference."
Study Design
Only postintervention (no control group)
Study Participants
Study participants included, "[t]en family doctors, who declared using computers during their consultations and consecutive consenting adult patients attending these doctors."