Essential data set for computer management of distributed primary care services

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon

Background

eHealth can positively impact the efficiency and quality of healthcare services. Its potential benefits extend to the patient, healthcare provider, and organization. Primary healthcare (PHC) settings may particularly benefit from eHealth. In these settings, healthcare provider readiness is key to successful eHealth implementation. Accordingly, it is necessary to explore the potential readiness of providers to use eHealth tools. Therefore, the purpose of this study was to assess the readiness of healthcare providers working in PHC centers in Lebanon to use eHealth tools.

Methods

A self-administered questionnaire was used to assess participants’ socio-demographics, computer use, literacy, and access, and participants’ readiness for eHealth implementation (appropriateness, management support, change efficacy, personal beneficence). The study included primary healthcare providers (physicians, nurses, other providers) working in 22 PHC centers distributed across Lebanon. Descriptive and bivariate analyses (ANOVA, independent t-test, Kruskal Wallis, Tamhane’s T2) were used to compare participant characteristics to the level of readiness for the implementation of eHealth.

Results

Of the 541 questionnaires, 213 were completed (response rate: 39.4 %). The majority of participants were physicians (46.9 %), and nurses (26.8 %). Most physicians (54.0 %), nurses (61.4 %), and other providers (50.9 %) felt comfortable using computers, and had access to computers at their PHC center (physicians: 77.0 %, nurses: 87.7 %, others: 92.5 %). Frequency of computer use varied. The study found a significant difference for personal beneficence, management support, and change efficacy among different healthcare providers, and relative to participants’ level of comfort using computers. There was a significant difference by level of comfort using computers and appropriateness. A significant difference was also found between those with access to computers in relation to personal beneficence and change efficacy; and between frequency of computer use and change efficacy.

Conclusion

The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

Essential dataset for ambulatory ear, nose, and throat care in general practice: an aid for quality assessment

OBJECTIVE

To describe the documentation of care for the usual range of ear, nose, and throat (ENT) problems seen in primary care as a basis for developing a computerised information system to aid quality assessment.

DESIGN

Descriptive study of the pattern of ENT problems and diagnoses and treatment as recorded in individual case notes.

SETTING

The primary health care centre in Mjölby, Sweden.

PATIENTS

Consultations for ENT problems from a 10% sample randomly selected from all consultations (n = 22,600) in one year. From this sample 375 consultations for ENT problems (16% of all consultations) by 272 patients were identified.

MAIN MEASURES

The detailed documentation of each consultation was retrieved from the individual records and compared with the data required for a computer based information system designed to help in quality management.

RESULTS

Although the overall picture gained from the data retrieved from the notes suggested that ENT care was probably adequate, the recorded details were limited. The written case notes were insufficient when compared with the details required for a computerised system based on an essential dataset designed to allow assessment of diagnostic accuracy and appropriateness of treatment of ENT problems in primary care.

CONCLUSION

There is a gap between the amount and the type of information needed for accurate and useful quality assessment and that which is normally included in case notes. More detailed information is needed if general practitioners' notes are to be used for regular quality assessment of ENT problems but that would mean more time spent on keeping notes. This would be difficult to justify.

IMPLICATIONS

The routine information systems used at this primary healthcare centre did not produce sufficient documentation for quality assessment of ENT care. This dilemma might be resolved by specially designed desktop computer software accessed through an essential dataset.