title: User satisfaction with a real-time automated feedback system for general practitioners: a quantitative and qualitative study.
abstract: OBJECTIVE
  The GRIF automated feedback system produces real-time comments on the appropriateness of diagnostic tests ordered by general practitioners (GPs) based on recommendations from accepted national and regional practice guidelines. We investigated the experiences of GPs with this system and, more specifically, with the recommendations produced by the system as well as their views on using this system in daily practice.
  
  
  METHODS
  We tested the GRIF system in an experiment in a laboratory setting and in a daily practice trial.
  
  
  METHODS
  General practitioners.
  
  
  METHODS
  In the laboratory experiment, GPs used the GRIF system to assess the appropriateness of 30 request forms. Each of the GPs was confronted with requests they had submitted to the diagnostic unit of the hospital in the past. In the field trial, the GRIF system was applied during patient consultations for 1 year.
  
  
  METHODS
  We measured GPs' satisfaction with the system using a questionnaire, and also conducted group discussions (in the laboratory experiment) and in-depth interviews (in the field trial) to elicit GPs' opinions of and experiences with the system. In addition, we explored GPs' reasons for not accepting the comments offered by the GRIF system.
  
  
  RESULTS
  The results show that the GPs in the laboratory experiment had more positive attitudes towards the system compared with participants in the field trial. All discussion groups and most of the GPs in the field trial regarded receiving the immediate feedback during the test ordering process as an important advantage. The most frequently mentioned reason to reject the recommendation was disagreement with the content and/or the recommendations in the practice guidelines.
  
  
  CONCLUSIONS
  Apart from securing agreement on guideline content, a prerequisite for using GRIF in daily practice on a large scale is that more attention is paid to promotion of the guidelines and their adoption, and stimulation of a positive attitude towards the practice guidelines among the users.
authors.affiliation: Department of Medical Informatics, Maastricht University, The Netherlands. r.bindels@mi.unimaas.nl
authors.forename: Rianne
authors.initials: R
authors.lastname: Bindels
authors.forename: Arie
authors.initials: A
authors.lastname: Hasman
authors.forename: Mieke
authors.initials: M
authors.lastname: Derickx
authors.forename: Jan W J
authors.initials: JW
authors.lastname: Van Wersch
authors.forename: Ron A G
authors.initials: RA
authors.lastname: Winkens
mesh_terms: D001291:Attitude of Health Personnel; D001292:Attitude to Computers; D020000:Decision Support Systems, Clinical; D003954:Diagnostic Services / Q000706:statistics & numerical data*; D005194:Family Practice / Q000193:education / Q000592:standards*; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010821:Physicians, Family / Q000523:psychology*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000592:standards; D011795:Surveys and Questionnaires; D014584:User-Computer Interface