医药学论文：医生处方系统论文+源程序-医学论文

医生处方系统论文
Determinants of physician use of an ambulatory prescription expert systemSummary
Purpose:
Methods:
Results:
Conclusion:
Keywords:
1. Introduction
Davis' 'Technology Acceptance Model' has been widely used to explain technology acceptance based on perceived ease of use and usefulness.Extending this work to medical informatics, Dixon conceptualized an 'Information Technology Adoption Model' and likewise found that perceived usefulness and ease of use were critical to self-reported adoption of computer systems in a survey of Canadian primary care physicians. Similarly, Dansky et al demonstrated that perceived organizational support and physician computer experience were positively associated with perceived usefulness of electronic records while computer anxiety and valuing close patient relationships were negative predictors of perceived utility. However, in neither Dixon nor Dansky''s surveys were physicians actually using electronic records (i.e. talking from experience) and both studies relied on self-report. Cork et al surveyed 771 academic physicians from five institutions regarding computers, but without respect to any specific systems implementation. They also found that favorable attitudes toward computers and technologic sophistication were positively associated with reported usage. Gadd and Penrod have examined physician attitudes toward ambulatory EMR use before and six months after EMR implementation. They reported diminished enthusiasm after the fact across multiple domains, but especially with respect to attitudes about system efficiency and usability. The authors, however, did not report on physician characteristics that might be associated with particular attitudes or adoption.
2. Methods
The computer attitude scale was derived from one previously validated by Cork et al. Their 16 item 'computer optimism' scale was unidimensional by factor analysis and we incorporated 8 of the top 9 loading items from this scale in our survey. These eight items were those most directly relevant to our purpose, assessing computer effect on doctor–patient rapport, quality of care, humaneness, patient satisfaction, teamwork, autonomy, cost, and 'enjoyment' of medical practice. These items were rated on a scale of 1–5 with 1: highly detrimental and 5: highly beneficial, with three being neutral. Human subjects approval was obtained prior to conducting the physician survey from the University of Virginia Human Investigations Committee.
3. Results
Respondents also rated whether they perceived the effect of omputers on medicine to be detrimental or beneficial with respect to eight attitudinal items that reflected the impact of computers on their enjoyment of medical practice, rapport with patients, quality of care, humaneness, patient satisfaction, physician communication, physician autonomy, and health care costs. Overall, the mean attitude toward computers (averaging the eight items) was 3.9 with individual item means ranging from 3.1 (effect on humaneness of the practice of medicine) to 4.6 (effect on quality of care) on the five point scale. Thus, most physicians had favorable attitudes toward the impact of computers on the practice of medicine.
System utilization rate (the number of electronic prescriptions written by each physician during the study period) was strongly associated with attitudes towards the expert system reflective of actual ease of use and usefulness (Table 3). Physicians believing that their patients liked them to use the system wrote far more electronic prescriptions on average as did those who felt it was helpful for organizing the medication list. Physicians with