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Primary care and hospital doctors’ experiences of prescribing information transfer using a shared electronic patient medical record system
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (Samhällsfarmaci)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy. (Samhällsfarmaci)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
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(English)Manuscript (preprint) (Other academic)
Abstract [en]

Rationale, aim and objective Uppsala county council has implemented a shared electronic patient medical record (e-PMR) system between primary and secondary care. Uppsala is one of the first counties in Sweden to implement such a system, and has the largest number of affiliated health care users with a shared e-PMR. The aim of this study was to investigate primary care and hospital doctors’ experiences of using the shared e-PMR, regarding information about individual patients’ drug therapies between the health care levels.

Method Semi-structured focus groups were conducted. Four groups were held with hospital and four with primary care doctors. Data were analysed from an interpretivist perspective, aiming at capturing the physicians’ perspective. They were coded, categorised and similar categories grouped into themes. The constant comparative method was used; all new data were compared to earlier data and earlier analyses, and categories were formed and reformed throughout the analysis. After analysis of the data from the separate groups, a mixed focus group was held with doctors from both primary care and hospital, in which the earlier findings were discussed, to explore variations in the data. The analysis was informed by the Data-Information-Knowledge-Wisdom hierarchy, where a differentiation is made between raw facts (data) and their conversion into, for example, a useful form for a particular context (knowledge).

Results The shared e-PMR was perceived as having many advantages, especially as all information was available electronically, which was convenient and time saving. The large amount of information, however, made it difficult to handle. The sought-after knowledge could be hard to retrieve in an information overload. Information about a patient’s drug therapy was not always collected in the medication list; additional information could be found in the e-PMR-notes, given by the patient or in the list of the patient’s automated medication dispensing service. Doctors did not summarize information as often, instead cross-referencing information that could be found elsewhere in the e-PMR.

Conclusions The information in the e-PMR needs to be structured in a comprehensible way to facilitate reading and knowledge production. It is not just about providing information, the knowledge needs to be communicated in a good way to the next care-giver.

Keyword [en]
computer-assisted drug therapy, prescription drugs, physician’s practice patterns, drug prescriptions, computerised medical records systems, continuity of patient care, hospital medication systems, drug utilisation review
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
URN: urn:nbn:se:uu:diva-132537OAI: oai:DiVA.org:uu-132537DiVA: diva2:358256
Available from: 2010-10-21 Created: 2010-10-21 Last updated: 2013-01-17Bibliographically approved
In thesis
1. Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
Open this publication in new window or tab >>Prerequisites and Responsibility for Appropriate Prescribing - the Prescribers' View
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore aspects of the subjective views and experiences of doctors as prescribers, focusing on responsibility for and factors of importance in achieving appropriate prescribing. To provide insights into the prescriber’s perspective the study designs were qualitative.

In the first studies secondary care doctors’ perceptions of appropriate prescribing and influences in prescribing were investigated in interviews. The doctors perceived that appropriate prescribing needed continuous revision. From the perspective of the prescribers the definition of prescribing could be rephrased as: “the outcome of the recurring processes of decision making that maximises net individual health gains within society’s available resources”. Among the influences in prescribing were guidelines, colleagues and therapeutic traditions.

In the subsequent studies the experiences of exchanging information regarding a patient’s drugs in an electronic patient medical record (e-PMR) shared between primary and secondary care and views of responsibility was explored, using focus groups with both primary and secondary care doctors. Considering the gap between health care levels, doctors’ views of responsibility in prescribing and exchange of information are of concern.

The doctors expressed how they assume information to be in the e-PMR and active information transfer has decreased. On the other hand, they experienced an information overload in the e-PMR system. There is a need for improved and structured communication between health-care givers. Taking responsibility to review all the patient’s medications was perceived as important, but described as still not done. Lack of responsibility taken was often due to acts of omission, i.e. that doctors did not make needed changes to the list of medications due to different barriers. The barriers rested both with individual doctors and the system, but to ensure solutions that are realisable in practise, perspectives of the doctors need to be taken into consideration when overcoming those barriers.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 81 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Pharmacy, ISSN 1651-6192 ; 131
Keyword
computer-assisted drug therapy, prescription drugs, physician’s practice patterns, drug prescriptions, computerised medical records systems, continuity of patient care, hospital medication systems, drug utilisation review, responsibility
National Category
Social and Clinical Pharmacy
Research subject
Social Pharmacy
Identifiers
urn:nbn:se:uu:diva-132544 (URN)978-91-554-7920-6 (ISBN)
Public defence
2010-12-04, B11-105, Biomedicinskt Centrum, Husargatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2010-11-12 Created: 2010-10-21 Last updated: 2011-01-13

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Ljungberg, ChristinaKettis, Åsa

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