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

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.