Student: Mary McLeod
Supervisors: Calder Botting & Pip Mason [Dept Public Health & General Practice and Pegasus Health]
Sponsor: Pegasus Health
Introduction and Aims
General practitioners (GPs) have been using computers for medical records and managing their practices from the 1990s. This has been a major shift from the traditional paper-based management system previously used. While there is huge potential for a computerized system to enhance the delivery of General Practice Services, there are still many areas that need to be improved in order for this potential to be reached.
Currently there are four different Practice Management Systems (PMS) available for GPs. These have a variety of features that cater for both clinical and non-clinical tasks involved in general practice. MedTech PMS is used by the Majority of Pegasus GPs so this project has focused on the utilisation and functionalities of Medtech. A previous study undertaken by Pegasus in 2007 identified six underutilised MedTech functions. This study aims to establish why these functions are not being used, the barriers to utilisation and the areas of unmet clinical needs in the current Practice Management System.
The identified MedTech features that this project focuses on are:
- Front Page displays a summary of important patient information that can be used as a patient overview.
- Query Builder is used to design queries to access information from the MedTech database.
- Outbox documents are documents and referrals that can be sent directly from the desktop computer via email, fax or health-link without printing.
- Audit is a tool used to calculate due and overdue recalls and coverage rates for immunisations and cervical screening.
- Special Authority application and acceptance allows request forms for medications that require a special authority number to be sent and received electronically from MedTech
- Patient information leaflets are 1-2 page documents with simplified information about a condition that can be printed and given to the patient.
The three aims of this project were to:
- Review formerly identified underutilised MedTech functions for clinical and non clinical tasks in Christchurch General Practices
- Identify barriers to the use of MedTech functions in General Practice
- Identify any consistent unmet needs in MedTech.
A total of 40 randomly selected Pegasus Health Practitioners, 20 GPs and 20 Nurses, were invited to take part in this study. Detailed information was sent out explaining what their involvement would entail. From these, 28 subjects volunteered to take part, 14 GPs and 14 Nurses. Data was collected through interviews based on questionnaires with a mixture of quantitative pre-coded questions and qualitative free text response.
The questionnaires covered the six functions that were previously identified as the most underutilised. The subjects were asked to rate on a scale of 1-5 (1=lowest, 5=highest) their usage, knowledge, usefulness or potential usefulness and the ease of using the feature (quantitative data). They were also asked to list any advantages or barriers to using the functions and for any further comments. Information was also gathered about the areas of unmet clinical needs in MedTech (qualitative data).
Data was entered into an Access database. Quantitative pre-coded questions were analysed in simple proportions and statistics using Excel. The qualitative free text responses were analysed using thematic analysis to identify common responses and trends.
Overall 28 out of the 40 GPs and Nurses participated in the study, which is a response rate of 70%. On average the participants had been using MedTech for 6-10 years and 82.1% had used another PMS prior to this. Use of the features investigated averaged 35.7%. Query Builder had the highest usage (78.6%) and the Patient Information Leaflet feature had the lowest usage (14.3%). The use of features varied between GPs and Nurses. Query Builder was used by 92.9% of Nurses compared to 64.3% of GPs, whereas Special Authority applications were made by 50% of GPs compared to 28.6% of Nurses.
The average knowledge about the features was rated 2.2 on a scale of 1-5 (5=excellent). The main barrier to use was limited knowledge (82.1%), and 43.5% of these indicated a need for further training and specified particular areas of need. A significant association was found between limited knowledge of the MedTech features and low usage (p<0.001). Barriers to use identified in the thematic analysis were poor formatting or layout and issues surrounding disease coding.
Identification of unmet needs was limited by the lack of knowledge of available or possible features. The main areas identified were voice recognition that works and a spell check function.
This study found that there was an association between low usage of the identified MedTech functionalities and knowledge of the users. There was also a definite pattern showing the need for further PMS training. The results provide valuable information for Pegasus Health on which to base content for further training modules for GPs and Practice Nurses. Improving the knowledge of MedTech users should result in an improvement in the efficient management of General Practices and the standard of delivery of General Practice Services to enhance best practice and improve patient health outcomes.