Perspectives of family physicians on computer-assisted health-risk assessments.
BACKGROUND
The firsthand experience of physicians using computer-assisted health-risk assessment is salient for designing practical eHealth solutions.


OBJECTIVE
The aim of this study was to enhance understanding about computer-assisted health-risk assessments from physicians' perspectives after completion of a trial at a Canadian, urban, multi-doctor, hospital-affiliated family practice clinic.


METHODS
A qualitative approach of face-to-face, in-depth, semi-structured interviews was used. All interviews were audio recorded and field notes taken. Analytic induction and constant comparative techniques were used for coding and analyses. Interpretation was facilitated by peer audit and insights gained from the social exchange theoretical perspective.


RESULTS
Ten physicians (seven female and three male) participated in the interviews. Three overarching themes emerged in relation to computer-assisted health-risk assessments: (1) perceived benefits, (2) perceived concerns or challenges, and (3) feasibility. Physicians unanimously acknowledged the potential of computer-assisted health-risk assessments to open dialogue on psychosocial health risks. They also appreciated the general facilitative roles of the tool, such as improving time-efficiency by asking questions on health risks prior to the consultation and triggering patients' self-reflections on the risks. However, in the context of ongoing physician-patient relationships, physicians expressed concerns about the impact of the computer-assisted health-risk assessment tool on visit time, patient readiness to talk about psychosocial issues when the purpose of the visit was different, and the suitability of such risk assessment for all visits to detect new risk information. In terms of feasibility, physicians displayed general acceptance of the risk assessment tool but considered it most feasible for periodic health exams and follow-up visits based on their perceived concerns or challenges and the resources needed to implement such programs. These included clinic level (staff training, space, confidentiality) and organizational level (time, commitment and finances) support.


CONCLUSIONS
Participants perceived computer-assisted health-risk assessment as a useful tool in family practice, particularly for identifying psychosocial issues. Physicians displayed a general acceptance of the computer tool and indicated its greater feasibility for periodic health exams and follow-up visits than all visits. Future physician training on psychosocial issues should address physicians' concerns by emphasizing the varying forms of "clinical success" for the management of chronic psychosocial issues. Future research is needed to examine the best ways to implement this program in diverse clinical settings and patient populations.


BACKGROUND
ClinicalTrials.gov NCT00385034; http://clinicaltrials.gov/ct2/show/NCT00385034 (Archived by WebCite at http://www.webcitation.org/5pV8AGRgt).
Ahmad
Farah
F
Social and Behavioral Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. farah.ahmad@utoronto.ca
Skinner
Harvey A
HA
Stewart
Donna E
DE
Levinson
Wendy
W
D000328:Adult; D003658:Decision Making, Computer-Assisted; D005240:Feasibility Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010821:Physicians, Family / Q000706:statistics & numerical data*; D011159:Population Surveillance; D018570:Risk Assessment / Q000379:methods*
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