On content of practice. The advantage of computerized information systems in family practice.

BACKGROUND

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.

OBJECTIVES

The main objectives of this study was to determine the advantage of computerized information systems in family practice.

MAIN RESULTS

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.

CONCLUSION

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.