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Tuesday, April 20, 2010

Sometimes Academic E-Health Researchers Are Rather out of Touch.

The following report caught my eye the other day.

Computers don’t improve care quality


By Michael East

The use of computers has had little impact on the quality of care GPs provide to their patients, a new study suggests.

Consultation times, the amount of problems managed in each encounter and referral rates to hospitals and specialists were the same among GPs who used computers and those who stuck to pen and paper, the study showed.

Analysing BEACH data, University of Sydney researchers grouped almost 1300 GPs according to their use of computers for test ordering, prescribing and medical recordkeeping.

The two groups were then compared on 34 quality indicators such as consultation times, referrals and ongoing management of conditions.

Writing in Quality in Primary Care (April), the study found the quality of care provided by both groups was almost identical.

More here:


I thought I should track down to original paper. Here is the abstract.


Effect of computerisation on Australian general practice: does it improve the quality of care?

Authors: Henderson, Joan1; Miller, Graeme2; Britt, Helena3; Pan, Ying4

Source: Quality in Primary Care, Volume 18, Number 1, February 2010 , pp. 33-47(15)

Publisher: Radcliffe Publishing Ltd.


Background: There is an assumption expressed in literature that computer use for clinical activity will improve the quality of general practice care, but there is little evidence to support or refute this assumption.

Aim: This study compares general practitioners (GPs) who use a computer to prescribe, order tests or keep patient records, with GPs who do not, using a set of validated quality indicators.

Methods: BEACH (Bettering the Evaluation and Care of Health) is a continuous national crosssectional survey of general practice activity in Australia. A sub-sample of 1257 BEACH participants between November 2003 and March 2005 were grouped according to their computer use for test ordering, prescribing and/or medical records. Linear and logistic regression analysis was used to compare the two groups on a set of 34 quality indicators.

Results: Univariate analyses showed that computerised GPs managed more problems; provided fewer medications; ordered more pathology; performed more Pap smear tests; provided more immunisations; ordered more HbA1c tests and provided more referrals to ophthalmologists and allied health workers for diabetes patients; provided less lifestyle counselling, and had fewer consultations with Health Care Card (HCC) holders. After adjustment, differences attributable solely to computer use were prescribed medication rates, lifestyle counselling, HCC holders and referrals to ophthalmologists. Three other differences emerged - computerised GPs provided fewer referrals to allied health workers and detected fewer new cases of depression, and fewer of them prescribed anti-depressants. Twenty-three measures failed to discriminate before or after adjustment.

Conclusion: Deciding on 'best quality' is subjective. While literature and guidelines provide clear parameters for many measures, others are difficult to judge. Overall, there was little difference between these two groups. This study has found little evidence to support the claim that computerisation of general practice in Australia has improved the quality of care provided to patients.


Document Type: Research article

Affiliations: 1: Senior Research Fellow, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Acacia House, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia. joanh@med.usyd.edu.au 2: Associate Professor, Medical Director, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia 3: Associate Professor, Director, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia 4: Senior Analyst, Family Medicine Research Centre, Discipline of General Practice, School of Public Health, University of Sydney, Australia

This study is really pretty much relevance free!

It is another retrospective look at computer use in BEACH responding GPs from over 5 years ago.

It is easy to understand why this took 5+ years to get researched and published – given its relevance to present practice. What computer were you using over 5 years ago – and is that at all that relevant to present practice? I think not.

Breathless reporting from Australian Doctor without mentioning how old the data analysed was does not help.

In the internet age if you can’t get data from the trenches to publication in a year or less just forget it!


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