AN IMPLEMENTATION STUDY OF THE PDRD PRIMARY-CARE COMPUTERIZED GUIDELINES

Objective - To study the implementation of electronic guidelines desig ned for general practitioners (GPs). Design - A descriptive 3-year fol low-up study. Subjects - All new subscribers to Physician's Desk Refer ence and Database (PDRD) in 1992. Setting - Locations of computers, wh ere PDRD software was installed for the first time in 1992. Main outco me measures - Expectations of the program and changes in attitudes tow ards it, getting started with the system, frequency and continuity of use and estimated usefulness of the program. Results - The guidelines were expected to enhance diagnostic accuracy (60% of subscribers), sav e time (45%), and reduce costs (11%). After 1 year's use, the opinions of the users on these topics had become slightly more positive. Techn ical problems delayed starting to use the program in 27%. After 1 year 72% were using the program at least weekly. Using frequency was assoc iated with having the computer in the office. The subscribers who rene wed their subscription after one year often became regular users. Conc lusions - The study provides insight into the implementation phase of computer-based guidelines in a population of early adopters. Technical support was essential to overcome the barriers associated with comput er technology. The perceived need for information was independent of t he age and experience of the physicians.