Njálsson T
Department of Family Medicine, University of Iceland, Iceland.
Scand J Prim Health Care. 1995 Nov;13 Suppl 1:1-102.
Computerized medical records have been widely used in family practice in Iceland for several years. Extensive data have been accumulated; however, how best to use and implement these data has been debated.
The main objectives of this study was to determine the advantage of computerized information systems in family practice.
The results provided broad epidemiological information on the content of family practice in Iceland. The study population consisted of 50,865 Icelanders and their 257,188 contacts with 17 community health centres over one whole year, 1988. Services were provided by 50 doctors, 43 nurses and nurses' assistants, and 7 midwives. Almost 90% of the rural population made at least one contact over the year of study; the mean rate of contacts per individual was 5.1, office visit 2.8-3.3, phone calls 1.1-1.6, and home-visits 0.4, females (40%) more often than males, increasing in number with increasing age. Disease symptoms were the reason for contact in 35-39% of cases, the initiative of the health care provider in 44-50%, and administration in 9-12%. The mean number of health problems recorded were 2.3 per individual per year. Extensive prevalence numbers are provided by age and sex. The largest categories were respiratory, injuries and musculoskeletal with a prevalence of over 200/1000 individuals per year. The most frequent contacts were made by persons with cancer and mental problems. The actions taken (processes) as a result of these contacts were numerous, an average of 1.6 per contact; 648 medications/1000 contacts, 141 laboratory tests, 126 surgical procedures, 15-24 referrals, and 15-26 hospital admissions. Prescriptions were most frequently for central nervous system medication (93-117/1000 contacts), for anti-infectives (100-106), and for cardiovascular (58-99). The cost of x-rays was shown to be $866 per 1000 contacts, and the odds for having an x-ray decreased by 18% for every 1000 individuals added to a practice. A quality study showed 16% of x-ray requests and 13% of office prescriptions were lacking.
The information obtained reflects health problems of the population as observed by family doctors. The information is useful for observing and influencing the health of a nation, the practices of health care providers, the generation of cost in the health system, and the use of appropriate health services. It is also useful to health care planners and researchers, as well as educators of health care providers. This study serves as a baseline for these tasks.
计算机化的医疗记录在冰岛的家庭医疗中已广泛使用数年。积累了大量数据；然而，如何最好地使用和应用这些数据一直存在争议。
本研究的主要目的是确定计算机化信息系统在家庭医疗中的优势。
结果提供了关于冰岛家庭医疗内容的广泛流行病学信息。研究人群包括50865名冰岛人及其在1988年一整年与17个社区卫生中心的257188次接触。服务由50名医生、43名护士及护士助理和7名助产士提供。在研究年度，近90%的农村人口至少有一次接触；每人的平均接触率为5.1次，门诊就诊2.8 - 3.3次，电话咨询1.1 - 1.6次，家访0.4次，女性（40%）比男性更频繁，且接触次数随年龄增长而增加。35 - 39%的接触原因是疾病症状，44 - 50%是医疗服务提供者主动发起，9 - 12%是行政事务。每人每年记录的健康问题平均数量为2.3个。按年龄和性别提供了广泛的患病率数据。最大的类别是呼吸系统、损伤和肌肉骨骼系统，每年患病率超过200/1000人。癌症和精神问题患者的接触最为频繁。因这些接触而采取的行动（过程）众多，每次接触平均1.6次；每1000次接触中有648次用药、141次实验室检查、126次外科手术、15 - 24次转诊和15 - 26次住院。处方最常开具的是中枢神经系统药物（93 - 117/1000次接触）、抗感染药物（100 - 106次）和心血管药物（58 - 99次）。X射线检查的费用显示为每1000次接触866美元，每个医疗单位每增加1000人进行X射线检查的几率降低18%。一项质量研究表明，16%的X射线检查申请和13%的门诊处方存在缺陷。
所获得的信息反映了家庭医生所观察到的人群健康问题。该信息对于观察和影响一个国家的健康状况、医疗服务提供者的实践、卫生系统的成本产生以及适当医疗服务的使用很有用。它对医疗保健规划者、研究人员以及医疗服务提供者的教育者也很有用。本研究为这些任务提供了一个基线。
