Tim Churches wrote:
Of course, ecological analysis in which groups (eg all patients cared
for by a particular GP) are assumed to be homogenous is easier to do and
the results are not necessarily wrong, but must be interpreted with
caution. It would be interesting if the data were re-analysed using a
multi-level model, with the individual patient data as the lowest level
of covariates, and the characteristics of their GP (including computer
use) as the second level of covariates. Unless, of course, the authors
of the study already did that, but looking at their presentation, I
don't think they did.
Tim,
That's a fair analysis, but at a more fundamental level their points
about hybrid recording systems, and cost and complexity - 'expensive and
time consuming' - are concerns that I've long held.
The hybrid issue has at least two recognised elements. One is where a GP
in a practice doesn't use the electronic system, but the rest do so the
electronic record is deficient as far as that GP's involvement, and
prescribing, is concerned.
The other is where part of the record, such as pathology results,
X-rays, specialist letters are held in a paper file while other parts of
the record are 'on computer'. The lack of efficiency is what disturbs me
most in this scenario.
The worst case is the particular souls who record everything they do in
both paper and electronically. These guys seem to come down to either
not wanting to give up the old, or don't trust the integrity/longevity
of the new, but can't jump one way or another fully.
In the first scenario, a really good study of the rates of adverse
events arising from drug interactions or allergy contraindications with
two groups of GPs, one computerised and one not, would be very
beneficial. I know there have been studies of hospital systems, poorly
implemented, that have shown problems with computer ordering in the
transition stages, but a long-term primary care study is another thing.
If some of you know of such studies the references would be appreciated
by all, I'm sure.
Greg
--
Greg Twyford
Information Management & Technology Program Officer
Canterbury Division of General Practice
E-mail: [EMAIL PROTECTED]
Ph.: 02 9787 9033
Fax: 02 9787 9200
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