ON CONTENT OF PRACTICE - THE ADVANTAGE OF COMPUTERIZED INFORMATION-SYSTEMS IN FAMILY-PRACTICE

Background - Computerized medical records have been widely used in fam ily practice in Iceland for several years. Extensive data have been ac cumulated; however, how best to use and implement these data has been debated. Objectives - The main objectives of this study was to determi ne the advantage of computerized information systems in family practic e. Main results - The results provided broad epidemiological informati on on the content of family practice in Iceland. The study population consisted of 50,865 Icelanders and their 257,188 contacts with 17 comm unity health centres over one whole year, 1988. Services were provided by 50 doctors, 43 nurses and nurses' assistants, and 7 midwives. Almo st 90% of the rural population made at least one contact over the year of study; the mean rate of contacts per individual was 5.1, office vi sit 2.8-3.3, phone calls 1.1-1.6, and home-visits 0.4, females (40%) m ore often than males, increasing in number with increasing age. Diseas e symptoms were the reason for contact in 35-39% of cases, the initiat ive of the health care provider in 44-50%, and administration in 9-12% . The mean number of health problems recorded were 2.3 per individual per year. Extensive prevalence numbers are provided by age and sex. Th e largest categories were respiratory, injuries and musculoskeletal wi th a prevalence of over 200/1000 individuals per year. The most freque nt contacts were made by persons with cancer and mental problems. The actions taken (processes) as a result of these contacts were numerous, an average of 1.6 per contact; 648 medications/1000 contacts, 141 lab oratory tests, 126 surgical procedures, 15-24 referrals, and 15-26 hos pital admissions. Prescriptions were most frequently for central nervo us system medication (93-117/1000 contacts), for anti-infectives (100- 106), and for cardiovascular (58-99). The cost of x-rays was shown to be $866 per 1000 contacts, and the odds for having an x-ray decreased by 18% for every 1000 individuals added to a practice. A quality study showed 16% of x-ray requests and 13% of office prescriptions were lac king. Conclusion - The information obtained reflects health problems o f the population as observed by family doctors. The information is use ful for observing and influencing the health of a nation, the practice s of health care providers, the generation of cost in the health syste m, and the use of appropriate health services. It is also useful to he alth care planners and researchers, as well as educators of health car e providers. This study serves as a baseline for these tasks.