Int J Med Inform - Healthcare professionals' adoption and use of a clinical information system (CIS) in primary care: insights from the Da Vinci study.

Tópicos

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Resumo

LABELLED: Given the increasing prevalence of multimorbidity in primary care (PC), interdisciplinary PC teams supported by appropriate clinical information systems (CIS) are needed in order to deal with the complexity of multimorbid patients' care. Our team has developed such a system, called the Da Vinci system. However, despite the expected benefits, evidence suggests generally low rates of CIS adoption. To optimize adoption in PC settings, a better understanding of the implementation process of such systems is crucial.PURPOSE: To identify user profiles, investigate the drivers of and barriers to adoption and use of the Da Vinci system, a PC tailored CIS, and understand the dynamics of the CIS adoption for each profile.METHODS: Using a longitudinal approach, we conducted a qualitative study (individual interviews, documentation and observation) based on the Diffusion of Innovation theory. It included 31 participants (primary care physicians, staff or residents, nurses, pharmacists) from two Family Medicine Groups in Quebec (Canada).RESULTS: The different user profiles drawn from the dynamics of implementation are linked to different sets of perceived drivers and barriers that evolve over time. Certain factors favour the decision of adopting Da Vinci early on: e.g. user skills and the system's expected ease of use and usefulness. Certain concerns hinder its adoption: e.g. perceived negative impact on the doctor-patient relationship. Over time, 5 factors appear to be related to more advanced exploitation of the system's functionalities: user skills, ease of use, comfort using the system in front of patients, support from colleagues and, more importantly, perceived positive impacts.CONCLUSIONS: A better understanding of the dynamics of CIS implementation provides insight into how best to encourage clinicians to adopt and make full use of such systems to improve the quality of care for multimorbid patients followed in PC settings.

Resumo Limpo

label given increas preval multimorbid primari care pc interdisciplinari pc team support appropri clinic inform system cis need order deal complex multimorbid patient care team develop system call da vinci system howev despit expect benefit evid suggest general low rate cis adopt optim adopt pc set better understand implement process system crucialpurpos identifi user profil investig driver barrier adopt use da vinci system pc tailor cis understand dynam cis adopt profilemethod use longitudin approach conduct qualit studi individu interview document observ base diffus innov theori includ particip primari care physician staff resid nurs pharmacist two famili medicin group quebec canadaresult differ user profil drawn dynam implement link differ set perceiv driver barrier evolv time certain factor favour decis adopt da vinci earli eg user skill system expect eas use use certain concern hinder adopt eg perceiv negat impact doctorpati relationship time factor appear relat advanc exploit system function user skill eas use comfort use system front patient support colleagu import perceiv posit impactsconclus better understand dynam cis implement provid insight best encourag clinician adopt make full use system improv qualiti care multimorbid patient follow pc set

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