Seeking health information online: does limited healthcare access matter?

Consumers facing barriers to healthcare access may use online health information seeking and online communication with physicians, but the empirical relationship has not been sufficiently analyzed. Our study examines the association of barriers to healthcare access with consumers’ health-related information searching on the internet, use of health chat groups, and email communication with physicians, using data from 27 210 adults from the 2009 National Health Interview Survey. Individuals with financial barriers to healthcare access, difficulty getting timely appointments with doctors, and conflicts in scheduling during clinic hours are more likely to search for general health information online than those without these access barriers. Those unable to get timely appointments with physicians are more likely to participate in health chat groups and email physicians. The internet may offer a low-cost source of health information and could help meet the heightened demand for health-related information among those facing access barriers to care.     

Organizational complements to electronic health records in ambulatory physician performance: the role of support staff

In industries outside healthcare, highly skilled employees enable substantial gains in productivity after adoption of information technologies. The authors explore whether the presence of highly skilled, autonomous clinical support staff is associated with higher performance among physicians with electronic health records (EHRs). Using data from a survey of general internists, the authors assessed whether physicians with EHRs were more likely to be top performers on cost and quality if they worked with nurse practitioners or physician assistants. It was found that, among physicians with EHRs, those with highly skilled, autonomous staff were far more likely to be top performing than those without such staff (OR 7.0, 95% CI 1.7 to 34.8, p=0.02). This relationship did not hold among physicians without EHRs (OR 1.0). As we begin a national push towards greater EHR adoption, it is critical to understand why some physicians gain from EHR use and others do not.     

The relation between personal characteristics of physicians and practice location in Manitoba.

A questionnaire survey of 562 physicians in Manitoba who had graduated from the University of Manitoba was carried out to assess the effect of personal characteristics on choosing a practice location. The results closely resemble those of studies performed in the United States: the choice of a nonurban practice location is significantly more likely if the physicians and their spouses have nonurban backgrounds and if the physicians have had a nonurban preceptorship during undergraduate medical education. In this study practitioners who were male and whose fathers were farmers or health care professionals were also more likely to practise in nonurban areas. These findings will help in making physician distribution more equitable.     

Use of Information and Communication Technologies in Clinical Practice Related to the Treatment of Pain. Influence on the Professional Activity and the Doctor-Patient Relationship

The increasing relevance of Information and Communication Technologies (ICTs) in medical care is indisputable. This evidence makes it necessary to start studies that analyse the scope these new forms of access to information and understanding of medicine have on the professional activity of the physician, on the attitude and on the knowledge of patients or, on the doctor-patient relationship. The purpose of this study is to explore some of these aspects in a group of physicians whose clinical activity is related to one of the greatest social impact health problems which is the treatment of chronic pain. Starting with the completion of a questionnaire, in the study group it is observed that the interaction between social structure, increase of information flows and ICTs generate transformations in social practices and behaviour of the actors of the health system. Internet is confirmed as an information space on the subject, but is shown as an underutilized space of interaction between the doctor and his patient.     

The impact of CyberHealthcare on the physician-patient relationship

It is estimated that 70 million Americans have used the Internet to acquire health-related information. Multiple factors provide the driving force behind this demand for online health information. Information technology is beginning to change the exclusive focus of medicine from curing disease to prevention of disease and enhancing health status. A critical feature of this change is the development of information and services that assist consumers to assume more responsibility for their own health and to actively participate in health care decisions. At the same time, physicians remain skeptical about the advantages of using the Internet for patient education. Some of the issues that this paper addresses include the following: What are the major factors that are leading to the increased use of the Internet by consumers to obtain health-related information? How do physicians view the use of the Internet by patients to obtain health-related information and services? How is the use of the Internet by consumers affecting physician-patient communications? What are the implications of the Internet for the future of physician-patient relationships?     

Physicians' Use of Key Functions in Electronic Health Records from 2005 to 2007: A Statewide Survey

Objective

Electronic health records (EHRs) have potential to improve quality and safety, but many physicians do not use these systems to full capacity. The objective of this study was to determine whether this usage gap is narrowing over time.

Design

Follow-up mail survey of 1,144 physicians in Massachusetts who completed a 2005 survey.

Measurements

Adoption of EHRs and availability and use of 10 EHR functions.

Results

The response rate was 79.4%. In 2007, 35% of practices had EHRs, up from 23% in 2005. Among practices with EHRs, there was little change between 2005 and 2007 in the availability of nine of ten EHR features; the notable exception was electronic prescribing, reported as available in 44.7% of practices with EHRs in 2005 and 70.8% in 2007. Use of EHR functions changed inconsequentially, with more than one out of five physicians not using each available function regularly in both 2005 and 2007. Only electronic prescribing increased substantially: in 2005, 19.9% of physicians with this function available used it most or all the time, compared with 42.6% in 2007 (p < 0.001).

Conclusions

By 2007, more than one third of practices in Massachusetts reported having EHRs; the availability and use of electronic prescribing within these systems has increased. In contrast, physicians reported little change in the availability and use of other EHR functions. System refinements, certification efforts, and health policies, including standards development, should address the gaps in both EHR adoption and the use of key functions.     

User Satisfaction with Computerized Order Entry System and Its Effect on Workplace Level of Stress

To evaluate the impact of Computerized Provider Order Entry (CPOE) on workplace stress and overall job performance, as perceived by medical students, housestaff, attending physicians and nurses, after CPOE implementation at Penn State—Milton S. Hershey Medical Center, an academic tertiary care facility, in 2005. Using an online survey, the authors studied attitudes towards CPOE among 862 health care professionals. The main outcome measures were job performance and perceived stress levels. Statistical analyses were conducted using the Statistical Analytical Software (SAS Inc, Carey, NC). A total of 413 respondents completed the entire survey (47.9 % response rate). Respondents in the younger age group were more familiar with the system, used it more frequently, and were more satisfied with it. Interns and residents were the most satisfied groups with the system, while attending physicians expressed the least satisfaction. Attending physicians and fellows found the system least user friendly compared with other groups, and also tended to express more stress and frustration with the system. Participants with previous CPOE experience were more familiar with the system, would use the system more frequently and were more likely to perceive the system as user friendly. User satisfaction with CPOE increases by familiarity and frequent use of the system. Improvement in system characteristics and avoidance of confusing terminology and inconsistent display of data is expected to enhance user satisfaction. Training in the use of CPOE should start early, ideally integrated into medical and nursing school curricula and form a continuous, long-term and user-specific process. This is expected to increase familiarity with the system, reducing stress and leading to improved user satisfaction and to subsequent enhanced safety and efficiency.     

Effects of residency training in family medicine v. internship training on professional attitudes and practice patterns.

OBJECTIVES: To determine whether the professional attitudes and practice patterns of physicians with residency training in family medicine differ from those of generalists with internship training. DESIGN: Mail survey conducted in 1985-86. SETTING: Province of Quebec. PARTICIPANTS: A stratified random sample of French-speaking family and general practitioners who graduated after 1972 (325 physicians with residency training and 304 with internship training) (response rate 82%). MAIN RESULTS: Physicians with residency training were 3 years younger on average than those with internship training, were more likely to be female (38% v. 18%, p less than 0.001) and were more likely to work on a salaried basis in CLSCs (public community health centres) (36% v. 14%, p less than 0.001). Even after these confounding factors were controlled for, physicians with residency training seemed to be more sensitive to the psychosocial aspects of patient care and tended to attach more importance to informing patients about useful materials and resources concerning their health problems. They were not, however, more likely to value health counselling or integrate it in medical practice. CONCLUSION: Our findings provide some evidence that the new requirement that physicians complete a residency in family medicine to obtain medical licensure in general practice in Quebec may foster a more patient-centred approach to health care.     

Nationwide online social networking for cardiovascular care in Korea using Facebook

To examine the use of online social networking for cardiovascular care using Facebook. All posts and comments in a Facebook group between June 2011 and May 2012 were reviewed, and a survey was conducted. A total of 298 members participated. Of the 277 wall posts, 26.7% were question posts requesting rapid replies, and 50.5% were interesting cases shared with other members. The median response time for the question posts was 16 min (IQR 8–47), which tended to decrease as more members joined the group. Many members (37.4%) accessed the group more than once a day, and more than half (64%) monitored the group posts in real time with automatic notifications of new posts. Most members expressed confidence in the content posted. Facebook enables online social networking between physicians in near-real time and appears to be a useful tool for physicians to share clinical experience and request assistance in decision-making.     

Physicians' assessment of deficiencies and desire for training in adolescent care

Over the past decade, there has been growing awareness among medical educators and care providers of the deficits in the training of primary care physicians to meet the health care needs of adolescents. The study reported here is the first national survey of primary care physicians' perceptions of their competency in dealing with adolescents' health concerns. In the survey, 351 internists, family practitioners, and pediatricians rated their competency in 19 areas of adolescent health care. Approximately three-quarters or more of the internists indicated deficits in all 19 areas. In areas related to gynecologic concerns, more pediatricians reported deficits than family physicians; but more family physicians than pediatricians reported deficiencies in managing acute conditions of youth (growth and developmental problems, endocrinopathies, school-based problems, and chronic illnesses). All physicians indicated deficiencies in dealing with high-risk health behaviors: eating disorders, drug and alcohol abuse, homosexuality, and delinquency. Finally, more than 45 percent of the physicians overall reported deficiencies in areas related to social and/or emotional concerns, including suicide, depression, and family conflicts. Despite these acknowledged deficits, most of the primary care physicians did not indicate adolescents to be the least desirable age group with which to work. However, few of the physicians expressed a desire to improve their skills. Overall, in none of the 19 areas did more than 30 percent of the physicians who had reported deficiencies in an area express interest in improving their competency.     

Correlates of Electronic Health Record Adoption in Office Practices: A Statewide Survey

Objective

Despite emerging evidence that electronic health records (EHRs) can improve the efficiency and quality of medical care, most physicians in office practice in the United States do not currently use an EHR. We sought to measure the correlates of EHR adoption.

Design

Mailed survey to a stratified random sample of all medical practices in Massachusetts in 2005, with one physician per practice randomly selected for survey.

Measurements

EHR adoption rates.

Results

The response rate was 71% (1345/1884). Overall, while 45% of physicians were using an EHR, EHRs were present in only 23% of practices. In multivariate analysis, practice size was strongly correlated with EHR adoption; 52% of practices with 7 or more physicians had an EHR, as compared with 14% of solo practices (adjusted odds ratio, 3.66; 95% confidence interval, 2.28–5.87). Hospital-based practices (adjusted odds ratio, 2.44; 95% confidence interval, 1.53–3.91) and practices that teach medical students or residents (adjusted odds ratio, 2.30; 95% confidence interval, 1.60–3.31) were more likely to have an EHR. The most frequently cited barriers to adoption were start-up financial costs (84%), ongoing financial costs (82%), and loss of productivity (81%).

Conclusions

While almost half of physicians in Massachusetts are using an EHR, fewer than one in four practices in Massachusetts have adopted EHRs. Adoption rates are lower in smaller practices, those not affiliated with hospitals, and those that do not teach medical students or residents. Interventions to expand EHR use must address both financial and non-financial barriers, especially among smaller practices.     

Attitudes of primary care physicians toward corporal punishment.

OBJECTIVE--The purpose of this study was to determine whether or not family physicians and pediatricians support the use of corporal punishment. The frequency with which these physicians offer anticipatory guidance on discipline was also studied. DESIGN--Self-report survey, mailed to study participants. PARTICIPANTS--The sample for this study was 800 family physicians and 400 pediatricians, randomly selected from the Ohio State Medical Board's roster of family physicians and pediatricians. Physicians with a subspecialty were excluded. Participants who did not return their surveys received a second, and if necessary, a third mailing of the survey. After three mailings, a total of 619 physicians (61%) completed a survey. MAIN OUTCOME MEASURE--Participants were considered to support corporal punishment if they would tell a parent in their medical practice that spanking would be an appropriate response to any one of a series of childhood misbehaviors presented in the survey. RESULTS--Of family physicians, 70% (95% confidence interval [CI], 66% to 75%) support use of corporal punishment. Of pediatricians, 59% (95% CI, 52% to 66%) support corporal punishment. Of pediatricians, 90% (95% CI, 86% to 94%) indicated that they include discipline issues either always or most of the time when providing anticipatory guidance to parents. Significantly fewer family physicians (52%; 95% CI, 47% to 57%) indicated that they discuss discipline either always or most of the time when providing anticipatory guidance (P less than .01). CONCLUSIONS--Most family physicians and pediatricians support the use of corporal punishment in spite of evidence that it is neither effective nor necessary, and can be harmful. Pediatricians offer anticipatory guidance on discipline more often than family physicians.     

Benchmarking health IT among OECD countries: better data for better policy

Objective

To develop benchmark measures of health information and communication technology (ICT) use to facilitate cross-country comparisons and learning.

Materials and methods

The effort is led by the Organisation for Economic Co-operation and Development (OECD). Approaches to definition and measurement within four ICT domains were compared across seven OECD countries in order to identify functionalities in each domain. These informed a set of functionality-based benchmark measures, which were refined in collaboration with representatives from more than 20 OECD and non-OECD countries. We report on progress to date and remaining work to enable countries to begin to collect benchmark data.

Results

The four benchmarking domains include provider-centric electronic record, patient-centric electronic record, health information exchange, and tele-health. There was broad agreement on functionalities in the provider-centric electronic record domain (eg, entry of core patient data, decision support), and less agreement in the other three domains in which country representatives worked to select benchmark functionalities.

Discussion

Many countries are working to implement ICTs to improve healthcare system performance. Although many countries are looking to others as potential models, the lack of consistent terminology and approach has made cross-national comparisons and learning difficult.

Conclusions

As countries develop and implement strategies to increase the use of ICTs to promote health goals, there is a historic opportunity to enable cross-country learning. To facilitate this learning and reduce the chances that individual countries flounder, a common understanding of health ICT adoption and use is needed. The OECD-led benchmarking process is a crucial step towards achieving this.     

基于小规模在线课程模式的职业卫生与职业医学在线开放课程的构建与应用研究

  目的  通过小规模在线课程(SPOC)模式的职业卫生与职业医学在线开放课程的构建与应用,探索适合该课程的新型教学模式,以期为教学改革研究提供范式和参考。  方法  选择14级与16级长沙医学院预防医学本科班学生为研究对象,以2016级预防医学专业本科班为实验组,采用SPOC教学模式;2014级预防医学专业本科班为对照组,采用常规线下教学。依托超星学习通平台,构建职业卫生与职业医学在线开放课程。在课程内容结构、教学方法、教学过程、考核机制等方面进行改革与探索,开展差异化教学。通过问卷满意度调查及课程考试成绩对该教学法进行教学效果评价。  结果  通过教学改革,职业卫生与职业医学在线开放课程的线上资源更加丰富和完善;16级预防班89.89%的学生对SPOC模式教学法总体评价表示满意;92.13%的学生认为提高了自己的自主学习能力;84.27%的学生对教师与同学们之间的互动表示满意;87.64%的学生觉得该教学法提供了丰富的教学资源;在团队协作能力、提高语言表达能力、查阅文献的能力均有不同程度提升。16级预防班实验操作考试成绩、理论成绩和总成绩均高于未改革的14级预防班,差异有统计学意义(均P＜0.05)。  结论  SPOC教学模式能够充分调动学生的积极性和主动性;一定程度上能提高学生对于知识点的掌握;可显著提高学生的学习效果,学生满意度良好,可为在线教学提供一种有效借鉴。      

From the Front Line,Report from a Near Paperless Hospital: Mixed Reception Among Health Care Professionals

ObjectiveMany Norwegian hospitals that are equipped with an electronic medical record (EMR) system now have proceeded to withdraw the paper-based medical record from clinical workflow. In two previous survey-based studies on the effect of removing the paper-based medical record on the work of physicians, nurses and medical secretaries, we concluded that to scan and eliminate the paper based record was feasible, but that the medical secretaries were the group that reported to benefit the most from the change. To further explore the effects of removing the paper based record, especially in regard to medical personnel, we now have conducted a follow up study of a hospital that has scanned and eliminated its paper-based record.DesignA survey of 27 physicians, 60 nurses and 30 medical secretaries was conducted. The results were compared with those from a previous study conducted three years earlier at the same department.MeasurementsThe questionnaire (see online Appendix) covered the frequency of use of the EMR system for specific tasks by physicians, nurses and medical secretaries, the ease of performing these tasks compared to previous routines, user satisfaction and computer literacy.ResultsBoth physicians and nurses displayed increased use of the EMR compared to the previous study, while medical secretaries reported generally unchanged but high use.ConclusionThe increase in use was not accompanied by a similar change in factors such as computer literacy or technical changes, suggesting that these typical success factors are necessary but not sufficient.     

城区社区卫生服务人才现状与对策

对静安寺街道社区卫生服务中心35岁以下的36名职工进行问卷调查。青年技术人才匮乏,人才队伍老化,尤其是35岁以下的公共卫生医师仅占总数的1／10;97％的青年人希望单位能提供更多的学习机会及更好的工作环境。因此只有通过建立健全工作制度、人才规划和分配机制,才能吸引人才、培养人才、留住人才,才能提高社区卫生人员素质,并达到促进社区卫生服务可持续发展的最终目的。     

Integrating complementary medicine and health care services into practice.

Complementary medicine and health care services constitute a significant proportion of the use of health care services in Canada, despite a history of limited acceptance of these therapies by the medical profession. However, physician attitudes appear to be changing. A survey of a random sample of general practitioners in Quebec (see page 29 of this issue) shows that four out of five general practitioners perceive at least one of three complementary health care services to be useful. Similar surveys of samples in Alberta and Ontario suggest that physicians there, although somewhat less enthusiastic than their counterparts in Quebec, have also begun to be more open-minded about these types of therapies. However, physicians have reported little understanding of complementary health care services, which suggests the need for more research on and education about these services. The Medical Society of Nova Scotia has responded to this need by establishing a Section of Complementary Medicine. The authors believe that fair, accountable, scientific and rigorous research on complementary therapies will benefit physicians and patients. The problems inherent in applying reductionist analysis to a holistic approach to care can be largely circumvented by focusing on outcomes research. In light of the popularity of these therapies, inquiry into patient use of complementary health care services should become a part of a complete patient history. This measure would promote greater patient-physician communication and integration of complementary health care services into patient care.     

基于家庭医生制度的上海市社区医生认知分析与政策建议(待续)

目的为进一步了解目前上海市社区医生对家庭医生制度认知和愿望,并深入分析这些原因,为上海市医改提出政策建议,特进行该研究。方法随机整群分层抽取上海市中心地区(徐汇区)、上海市城乡结合区(闵行区)、上海市郊区(金山区)社区(家庭)医生1300人,有效回答1142份,回收率87.8%。结果①对于家庭医生的资质,医务人员认为家庭医生应该由31～50岁之间、具备大学(含专科)学历和初级或中级职称、从业在5年以上的基层医疗卫生服务人员来担当。②在家庭医生提供基本医疗服务项目方面,有23.7%的医务人员认为非常必要;在提供公共卫生服务项目方面,认为非常需要的医务人员占26%;对于家庭健康管理服务项目,有50.1%的医务人员认为家庭医生需要提供该服务。在双向转诊方面,有17.77%的医务人员认为家庭医生应该提供此项服务。而关于提供将患者的健康档案信息上报,并在二、三级医院进行门诊预约、检验、检查的服务,则有18.65%的医务人员认为家庭医生应该提供此项服务。③在综合满意度方面,仅有5.5%的社区医务人员对目前的各方面状况表示非常满意。结论上海市社区医生认知较好,要因势利导,制定相关政策,保证家庭医生制度的顺利实现。社区医生培养更是当务之急。     

病人流向适宜程度的探讨

比较1997年和1992年两次卫生服务调查病人流向发现：（1）农村I级医疗机构门诊病人占85％,城市只占38％;（2）城市私人开业门诊量1997年比1992年明显增加,农村有所下降;（3）农村三级医疗机构网门诊量分布村级卫生机构占55％,县乡两级合占45％。合理调整病人流向在城市应大力发展社区卫生服务,农村应以提高卫生服务质量为主。