Abstract
Objective To examine the use of computers in primary care practices.
Design The international Quality and Cost of Primary Care study was conducted in Canada in 2013 and 2014 using a descriptive cross-sectional survey method to collect data from practices across Canada. Participating practices filled out several surveys, one of them being the Family Physician Survey, from which this study collected its data.
Setting All 10 Canadian provinces.
Participants A total of 788 family physicians.
Main outcome measures A computer use scale measured the extent to which family physicians integrated computers into their practices, with higher scores indicating a greater integration of computer use in practice. Analyses included t tests and Embedded Image2 tests comparing new and traditional models of primary care on measures of computer use and electronic health record (EHR) use, as well as descriptive statistics.
Results Nearly all (97.5%) physicians reported using a computer in their practices, with moderately high computer use scale scores (mean [SD] score of 5.97 [2.96] out of 9), and many (65.7%) reported using EHRs. Physicians with practices operating under new models of primary care reported incorporating computers into their practices to a greater extent (mean [SD] score of 6.55 [2.64]) than physicians operating under traditional models did (mean [SD] score of 5.33 [3.15]; t726.60 = 5.84; P < .001; Cohen d = 0.42, 95% CI 0.808 to 1.627) and were more likely to report using EHRs (73.8% vs 56.7%; Embedded Image ; P < .001; odds ratio = 2.15). Overall, there was a statistically significant variability in computer use across provinces.
Conclusion Most family physicians in Canada have incorporated computers into their practices for administrative and scholarly activities; however, EHRs have not been adopted consistently across the country. Physicians with practices operating under the new, more collaborative models of primary care use computers more comprehensively and are more likely to use EHRs than those in practices operating under traditional models of primary care.
Computers are used in primary care offices for a variety of reasons, including writing prescriptions, referrals, billing, scheduling tests and appointments, and electronic record keeping.1,2 The use of computers can help organize medical information and facilitate communication between providers.3 Integrating computers into primary care practice also has clinical implications, as it influences the patient-physician relationship and can have a positive effect on clinical outcomes.1,4
One important way that computers are being used in primary care is to keep electronic health records (EHRs) or electronic medical records. Although the terms electronic health records and electronic medical records are not the same by definition,* in practice they are conflated and used interchangeably throughout the literature.2,5 Electronic health records have been shown to have a positive effect on structural practice issues and health care processes such as coordination of care, communication, and care for patients with complex needs; however, the effect of EHR use on clinical outcomes is less clear and the debate is ongoing.1,3,4,6–10
Recent research suggests that the model of care also affects patients and physicians, including patient access to care, physician satisfaction, and the patient-physician relationship.4,11–13 Primary care is the most important entry point into the health care system in Canada, and is the first step for many when obtaining clinical services.14 To ensure that primary care is functioning well and providing necessary care, substantial revisions have been made to primary care delivery models in Canada in recent years.15,16 Some provinces have supported new primary care practice models that are based on integrating physicians and other health care providers to work collaboratively to provide more comprehensive care.16,17 Traditional models of care, on the other hand, tend to be less team-oriented and more solo practices, and often use a fee-for-service payment model.18 Although research reveals that new models of primary care have some advantages, such as greater patient involvement and physician job satisfaction, these new models of care have not been adopted evenly across provinces. (Detailed descriptions of new and traditional models of care by province have been published previously.11,19,20) Health care delivery models differ considerably between the provinces because health care in Canada falls under provincial jurisdiction, not federal, and some provinces support new primary care practice models more vigorously than others do.17,21
As there is a lack of research on how differing models of primary care practice incorporate computer use, the relationship between computer use and models of care is investigated in this study. Given the focus on collaboration and integration in new models of care, it was expected that physicians in new-model practices would be more likely to integrate computers in order to facilitate communication with other providers.
The objective of this study was to examine the use of computers in Canadian primary care practices using the data set from the Quality and Cost of Primary Care (QUALICOPC) study. Three research questions were posed: How do Canadian family physicians use computers in their practices? To what extent do Canadian family physicians in different provinces use EHRs in their practices? and Does computer use differ between physicians who operate their practices under new models of primary care and those who operate under traditional models of primary care?