Abstract
Objetivo
Conocer las actitudes y expectativas de los médicos respecto del proceso de informatización de la atención primaria (AP).
Diseño
Investigación cualitativa mediante grupos de discusión.
Participantes
Un total de 31 médicos de las 2 comarcas de AP de Gipuzkoa.
Método
Muestreo intencional estratificado según comarcas y grado de experiencia en el uso de ordenador en la consulta. Realización de 5 grupos de discusión con grabación y transcripción del contenido previa autorización y garantía de confidencialidad. Análisis cualitativo de las anotaciones y transcripciones con ayuda de soporte informático. Validación mediante envío de los resultados a los participantes y discusión entre los autores.
Resultados
La incorporación del ordenador en la consulta de AP repercute tanto en el ordenamiento como en el contenido de la información registrada. El esfuerzo por «conocer lo que se hace» no se acompaña de experiencias evaluadoras posteriores. Se advierten notables deficiencias en la gestión del proceso de informatización. El uso del ordenador genera efectos simbólicos añadidos tanto sobre los pacientes como sobre los médicos.
Conclusiones
La informatización de la AP constituye un proceso cuyas repercusiones sobre la atención médica distan de ser neutras y, por lo tanto, requiere de rigurosa discusión y evaluación. La definición de objetivos escalonados y medibles, la transparencia en la gestión y la promoción de investigaciones evaluativas favorecerían el desarrollo eficaz de los proyectos de informatización en AP.
Palabras clave: Informatización, Atención primaria, Evaluación de programas, Investigación cualitativa
Abstract
Objective
To find the attitudes and expectations of doctors during the process of computerising primary care (PC).
Design
Qualitative investigation through discussion groups.
Participants
Thirty-one doctors from the two PC regions of Gipuzkoa.
Method
Intentional stratified sampling by regions and by experience in using a computer in the consulting-room. Five discussion groups with recording and transcription of the contents with prior authorisation and guarantee of confidentiality. Qualitative analysis of the notes and transcriptions with the help of computer back-up. Validation through sending of results to participants and discussion between the authors.
Results
Introducing computers into PC consulting-rooms had repercussions both on the ordering and contents of the information recorded. The effort «to know what is being done» was not accompanied by subsequent evaluation. Notable deficiencies in management of the computerising process were perceived. Computer use created additional symbolic effects for both patients and doctors.
Conclusions
Computerising PC is a process whose repercussions on medical care are far from neutral and so require rigorous discussion and evaluation. Defining step-by-step and measurable objectives, transparency in management and the promotion of evaluative research would all favour the effective development of projects to computerise PC.
Key words: Computerisation, Primary care, Evaluation of programmes, Qualitative research
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