Bell Douglas S, Daly Dianna M, Robinson Paul
UCLA Division of General Internal Medicine and Health Services Research, 911 Broxton Plaza, Room 314, Los Angeles, CA 90095-1736, USA.
J Am Med Inform Assoc. 2003 Sep-Oct;10(5):484-93. doi: 10.1197/jamia.M1341. Epub 2003 Jun 4.
The aim of this study was to determine whether physician offices located in high-minority and low-income neighborhoods have different levels of access to information technology than offices located in lower-minority and higher-income areas.
A cross-sectional survey was conducted of pediatrics, family medicine, and general practice offices in Orange County, California. Survey data were linked with community demographic data from the 2000 Census using a geographical information system.
Of 307 offices surveyed, 141 responded (46%). Offices located in high-minority and high-poverty areas were as likely to respond as other offices. Among responding offices, 94% had a computer, 77% had Web access, 29% had broadband Internet access, and 53% used computerized scheduling and billing systems. Offices located in minority and low-income communities had equivalent access to each technology. Offices in communities with larger proportions of Hispanics were less likely to have practice Web pages, but other uses of the Internet were not associated with practice location. Offices reported high levels of interest in online clinical systems but also high levels of concern about these systems' usability and confidentiality. Offices with Web access and those with practice management systems expressed greater interest in online clinical systems but also greater levels of concern about usability and confidentiality. These attitudes were equivalent among offices in different communities.
Primary care offices located in poor and minority communities in a large, suburban county had high levels of access to and interest in Web-based systems. Physicians' offices may therefore provide a venue for online services aimed at improving health outcomes for poor and minority communities. Research is needed in other geographic regions to determine the generalizability of these findings.
本研究旨在确定位于少数族裔比例高和低收入社区的医生诊所与位于少数族裔比例低和高收入地区的诊所相比，在信息技术获取水平上是否存在差异。
对加利福尼亚州奥兰治县的儿科、家庭医学和全科诊所进行了横断面调查。使用地理信息系统将调查数据与2000年人口普查的社区人口统计数据相链接。
在接受调查的307家诊所中，141家做出了回应（46%）。位于少数族裔比例高和贫困率高的地区的诊所与其他诊所做出回应的可能性相同。在做出回应的诊所中，94%拥有电脑，77%可以上网，29%拥有宽带互联网接入，53%使用计算机化的预约和计费系统。位于少数族裔和低收入社区的诊所对每项技术的获取情况相当。西班牙裔比例较高的社区中的诊所拥有执业网页的可能性较小，但互联网的其他用途与诊所位置无关。诊所对在线临床系统表现出高度兴趣，但也对这些系统的可用性和保密性高度关注。可以上网的诊所和拥有执业管理系统的诊所对在线临床系统表现出更大兴趣，但对可用性和保密性的担忧程度也更高。不同社区的诊所之间这些态度相当。
在一个大型郊区县的贫困和少数族裔社区中的基层医疗诊所对基于网络的系统有较高的获取水平和兴趣。因此，医生诊所可能为旨在改善贫困和少数族裔社区健康结果的在线服务提供一个场所。需要在其他地理区域进行研究以确定这些发现的普遍性。
