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利用信息提供更安全的医疗服务:一项混合方法研究,探索伦敦西北部初级医疗中全科医生的信息需求。

Using information to deliver safer care: a mixed-methods study exploring general practitioners' information needs in North West London primary care.

作者信息

Mastellos Nikolaos, Car Josip, Majeed Azeem, Aylin Paul

机构信息

Imperial College London.

出版信息

J Innov Health Inform. 2014 Dec 8;22(1):207-13. doi: 10.14236/jhi.v22i1.77.

Abstract

BACKGROUND

The National Health Service in England has given increasing priority to improving inter-professional communication, enabling better management of patients with chronic conditions and reducing medical errors through effective use of information. Despite considerable efforts to reduce patient harm through better information usage, medical errors continue to occur, posing a serious threat to patient safety.

OBJECTIVES

This study explores the range, quality and sophistication of existing information systems in primary care with the aim to capture what information practitioners need to provide a safe service and identify barriers to its effective use in care pathways.

METHOD

Data were collected through semi-structured interviews with general practitioners from surgeries in North West London and a survey evaluating their experience with information systems in care pathways.

RESULTS

Important information is still missing, specifically discharge summaries detailing medication changes and changes in the diagnosis and management of patients, blood results ordered by hospital specialists and findings from clinical investigations. Participants identified numerous barriers, including the communication gap between primary and secondary care, the variable quality and consistency of clinical correspondence and the inadequate technological integration.

CONCLUSION

Despite attempts to improve integration and information flow in care pathways, existing systems provide practitioners with only partial access to information, hindering their ability to take informed decisions. This study offers a framework for understanding what tools should be in place to enable effective use of information in primary care.

摘要

背景

英国国家医疗服务体系越来越重视改善跨专业沟通,以便更好地管理慢性病患者,并通过有效利用信息减少医疗差错。尽管为通过更好地使用信息来减少患者伤害付出了巨大努力,但医疗差错仍不断发生,对患者安全构成严重威胁。

目的

本研究探讨初级医疗中现有信息系统的范围、质量和复杂性,旨在了解从业者提供安全服务所需的信息,并确定在护理路径中有效使用这些信息的障碍。

方法

通过对伦敦西北部诊所的全科医生进行半结构化访谈以及一项评估他们在护理路径中使用信息系统经验的调查来收集数据。

结果

重要信息仍然缺失,特别是详细说明用药变化以及患者诊断和管理变化的出院小结、医院专科医生开出的血液检查结果以及临床检查结果。参与者指出了许多障碍,包括初级医疗和二级医疗之间的沟通差距、临床通信质量和一致性的差异以及技术整合不足。

结论

尽管试图改善护理路径中的整合和信息流,但现有系统仅为从业者提供部分信息访问权限,阻碍了他们做出明智决策的能力。本研究提供了一个框架,用于理解应具备哪些工具才能在初级医疗中有效利用信息。

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