Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia Class 17. 1 st year. 2010/2011.

Apresentação em tema: "Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia Class 17. 1 st year. 2010/2011."— Transcrição da apresentação:

1 Curricular unit: Introduction to Medicine II Adviser: Ricardo João Cruz Correia Class 17. 1 st year. 2010/2011

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3 General governments objective: Related projects being carried out: – epSOS (1) – the European-wide project to patient data interchange among countries, particularly focused on emergency situations – RSE (2) – the Portuguese program for a centralized patient records database and sharing system 3 (1)http://www.epsos.eu/ (2)http://www.portaldasaude.pt/portal/conteudos/a+saude+em+portugal/politica+da+saude/discussao/arquivo/registo+electronico.htm centralization of all medical records in a single country-wide electronic sharing system

4 One known evaluation study (3) about the importance of a regional electronic health information exchange system: – Based on questionnaires answered by New York ER Doctors; – Possible bias due to the distribution method used. In Portugal: no released investigations about the subject. 4 Conclusion (3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency Physicians Perceptions of Health Information Exchange. J Am Med Inform Assoc. 2007 Nov–Dec; 14(6) :700-705 developing a patient record database is important.

5 5 1 Scarcity of studies/evaluations proving the viability of the projects and low quality of the available information; 2 Reduced query to specialists working in the fields that the projects would potencially give benefit to; 3 Ambiguous justifications by the entities working on the projects for their implementation;

6 Main question: Objectives/Aims: – Gathering opinions from health professionals about the usefulness of this kind of systems; – Determining which type of information and type of institution whose information health professionals would find the most important to have access to; – Comparing results obtained in this project to those of Shapiros study. 6 Would the health professionals find the existence of an electronic system sharing medical information among health institutions useful?

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8 TARGET POPULATION Doctors Nurses SAMPLING LOCATIONS (institutions chosen for convenience) Hospitals Hospital S. João Hospital Pedro Hispano (data share system implemented) Hospital Cuf Porto Primary CareHealth Centers of ARS Norte – doctors of primary care 8 DEPARTMENTS Emergency department Internal medicine General surgery Pediatrics Otorhinolaryngology Departments selection criteria: addition of variables of (potential) interest DATA COLLECTING METHODS: survey (paper and online)

9 9 Cross-sectional study – Pointed to a specific moment in time Cross-sectional study – Pointed to a specific moment in time Observational study – No intervention Observational study – No intervention

10 10 Main critics to the survey: Nurses, some doctors: asking for percentages with no sense in some questions; gradatory scale Difficulties on the comprehension of question 4 (which features would benefit from the system) ; modified Several suggestions for the answer of question 6 (which type of information would be the most useful) ; turned into an open question 9 doctors 4 nurses

11 Sent 11 March (after phone conversation) Hand-delivered (after direct conversation) 11 Contents: Request for Authorization (letter) Request for Authorization (letter) Survey Survey Written Protocol Written Protocol Letters

12 Support in study Disclosure of the survey by e-mail General Practice (GPs) Doctors 12 http://http://newdbserver.med.up.pt/projext/medquest/verprod/index.php?mdl=3&qtr=MTQyNzcxMDUxNDI= MedQuest

13 13 Hospital Department Hospital S. João Hospital Pedro Hispano Hospital Cuf Porto Online DeliveredFilledDeliveredFilledDeliveredFilled N=46 Emergency department Required written approval : Ethics committee Hospitals direction XX Internal medicine XXXXX General surgeryUnavailable XX Pediatrics XLost XXX Otorhinolaryngology XXXXX N=67

14 14 Descriptive analysis - using PASW (SPSS) Descriptive analysis - using PASW (SPSS) Comparative analysis – acording to selected variables Comparative analysis – acording to selected variables Type of health professional: Doctors/ Nurses Type of institution: Public/ Private institutions Gender: Female/ Male Age: Younger/ Older professionals Survey format: Online/ Printed version

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16 16 Occupation Doctor: 40% Nurse: 59% Gender Female: 65% Male: 34% Age 21 – 30: 50% 31 – 40: 26% 41 – 50: 14% 51 – 60: 7% Female: 47% Male: 52% PAPER ONLINE All primary care doctors 21 – 30: 20% 31 – 40: 20% 41 – 50: 11% 51 – 60: 48% N=67 N=46

17 17 1.Com que frequência é que actualmente procura obter informações clínicas sobre os doentes a quem presta cuidados de saúde, de fontes fora da sua instituição de saúde? Comparative Analysis

18 18 2. Se lhe fosse dado um fácil acesso a informação clínica proveniente de fora da sua instituição de saúde, quais as fontes de dados que lhe seriam mais úteis? (Por favor, ordene as seguintes fontes em função da sua utilidade, em que a 1ª é a mais útil e a 4ª é a menos útil. Use cada número apenas uma vez.) Ordem de utilidade Hospitais Centros de Saúde Laboratórios de análises e imagiologia Clínicas e/ou consultórios médicos privados 1º 60,6%22,7%12,1%4,5% 2º 29,8%40,2%19,4%10,4% 3º 9%25,4%41,8%23,9% 4º 1,5%11,7%26,5%60,3% 1º 69,4%12,2%14,3%4,1% 2º 17,4%28,3%47,8%6,5% 3º 2,4%45,2%33,3%19,0% 4º4,9%14,6%4,9%75,6% Health Centers Hospitals

19 19 3. Qual a proporção de doentes a quem presta cuidados de saúde que beneficiariam, se o acesso à informação clínica proveniente de fora da sua instituição de saúde fosse imediato? Comparative Analysis

20 20 4. Assinale a sua concordância relativamente aos aspectos/instituições que iriam ser beneficiados, caso existisse a possibilidade de obter informação clínica de outras instituições de saúde de maneira rápida e fácil. A forma como presta os cuidados de saúde O seu serviço/departame nto A sua instituição de saúde O Sistema Nacional de Saúde Hospitals Health centers Hospitals Health centers Hospitals Health centers Hospitals Health centers Concordo Plenamente 24,2%63%18,5%54,3%25,4%56,5%35,8%63% Concordo 65,2%34,8%76,9%43,5%70,1%43,5%59,7%32,6% Discordo 10,6%2,2%4,6%-3%-1,5%2,2% Discordo Totalmente -------2,2% Sem opinião ---2,2%1,5%-3%-

21 21 5.Em relação a cada um dos seguintes factores assinale o tipo e grau de efeito que, na sua opinião, iria ter pelo acesso a informação proveniente de outra instituição de saúde. Eficiência (melhor utilização de recursos) com que os cuidados de saúde são prestados Tempo necessário para tomar decisões sobre os utentes a quem presto cuidados de saúde Número de Meios Complementares de Diagnostico e Terapêutica (MCDT) solicitados Número de erros na prestação de cuidados de saúde Hospitals Health centers Hospitals Health centers Hospitals Health centers Hospitals Health centers Piorar muito -------2,3% Piorar -------- Sem alterações 9%-3%4,3%3%-24,6%18,2% Melhorar 44,8%21,7%52,2%50%43,3%34,8%45,9%52,3% Melhorar muito 46,3%78,3%44,8%43,5%53,7%65,2%29,5%27,3% Não sei ---2,2%----

22 22 6. Faça uma lista de pelo menos 5 tipos de documentos clínicos que, se disponíveis noutras instituições de saúde, lhe seriam muito úteis na sua prática clínica. Comparative Analysis

23 23 7 - RSE 7.1 Já alguma vez ouviu falar deste projecto?

24 24 7.2 Qual acha que será a utilidade da sua implementação? 7 - RSE Comparative Analysis

25 25 7.2 Qual acha que será a utilidade da sua implementação? 7 - RSE Hospital S. João vs. Hospital CUF Porto Public vs. Private 27% 59% 55% 14% 18% Comparative Analysis

26 26 Results of Shapiros survey Results of our survey Response rate: 58% (n=216) 63% of the doctors said that more than 1/4 of their patients would benefit from the data sharing system 85% said it was difficult to access information from external sources 56% said that they try to access external data < than 10% of the times needed Response rate: 26% (Doctors CUF=44) 66% of the doctors said that a lot/all of their patients would benefit from the data sharing system 48% said they frequently/always search for information 89% said the efficiency of the health care would improve/greatly improve if they could access the external data Comparative Analysis

27 27 Meeting the objectives: The majority of health professionals believe that a patient record exchange system, particularly RSE in our countrys context, would be very useful or even essential. Hospitals are the most searched sources of external patient data. The medical documents that health professionals would find more useful to obtain are: MCDT Clinical analysis Imaging exams Appointment and subspecialties reports Discharge reports.

28 28 (1) Welcome to epSOS – a European eHealth Project. In epSOS: Home. Retrieved October 21, 2010, from http://www.epsos.eu/ (2) Registo de saúde electrónico. In Portal da Saúde. Retrieved October 21, 2010, from http://www.portaldasaude.pt/portal/conteudos/a+saude+em+port ugal/politica+da+saude/discussao/arquivo/registo+electronico.htm (3) Shapiro JS, Kannry J, Kushniruk AW, Kuperman G. Emergency Physicians Perceptions of Health Information Exchange. J Am Med Inform Assoc. 2007 Nov–Dec; 14(6) :700-705

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