Early experience of the use of short message service (SMS) technology in routine clinical care.

OBJECTIVE: To conduct a technical appraisal and qualitative interviews with short message service (SMS--mobile phone text message) users in mainstream health care. DESIGN: Observation of service usage followed by in-depth semi-structured interviews. SETTING: A National Health Service (NHS) general practice in Scotland. PARTICIPANTS: One hundred and eighty patients registered. MAIN OUTCOME MEASURES: Service utilisation and patients' views. RESULTS: It was technically feasible to open up access to mainstream NHS general practice services using SMS for appointment booking, repeat prescription ordering, clinical enquiries and remote access to the core clinical summary. CONCLUSION: Patients were able to use SMS services responsibly and found automation of prescription ordering particularly useful. Service utilisation was modest and did not adversely impact on the workload of general practitioners (GPs) or their staff.

Clinical symptoms and 'off-label' prescribing in children with asthma.

A UK-wide database of structured asthma review consultations was used to investigate the prevalence of 'off-label' anti-asthma prescriptions in relationship to clinical symptoms of asthma control. The 1050 children (6.1%) aged 16 years or under issued with an off-label prescription reported more nighttime, daytime and activity asthma symptoms, and used more short-acting beta(2)-agonist medication than their peers. Off-label prescribing for children with asthma in UK primary care is associated with worse levels of self-reported asthma control.

Patient and health care professional views and experiences of computer agent-supported health care.

OBJECTIVES: To explore patient and health care professional (HCP) views towards the use of multi-agent computer systems in their GP practice. DESIGN: Qualitative analysis of in-depth interviews and analysis of transcriptions. SETTING: Urban health centre in Dundee, Scotland. PARTICIPANTS: Five representative healthcare professionals and 11 patients. MAIN OUTCOME MEASURES: Emergent themes from interviews revealed participants' attitudes and beliefs, which were coded and indexed. RESULTS: Patients and HCPs had similar beliefs, attitudes and views towards the implementation of multi-agent systems (MAS). Both felt modern communication methods were useful to supplement, not supplant, face-to-face consultations between doctors and patients. This was based on the immense trust these patients placed in their doctors in this practice, which extended to trust in their choice of communication technology and security. Rapid access to medical information increased patients' sense of shared partnership and self-efficacy. Patients and HCPs expressed respect for each other's time and were keen to embrace technology that made interactions more efficient, including for the altruistic benefit of others less technically competent. CONCLUSIONS: Patients and HCPs welcomed the introduction of agent technology to the delivery of health care. Widespread use will depend more on the trust patients place in their own GP than on technological issues.

An academic, pharmaceutical and practice collaboration to implement asthma guidelines.

AIMS: To investigate whether a patient review service changes the management of asthma in accordance with BTS/SIGN Guidelines. METHODS: An observational study of routine review consultations for patients with asthma registered at 862 practices throughout the United Kingdom. Practices recorded reviews on a computer template and returned the information to an academic unit for analysis. RESULTS: 41,493 patients had data returned with 14,790 (36%) patients reporting symptoms at rest or on a daily basis and 15,840 (38%) patients over-using their short-acting beta2-agonist. 4,556 (74%) of patients with symptoms who had a subsequent consultation reported a reduction in their symptoms, whilst 3,932 (63%) reported a reduction in short-acting beta2-agonist use. Night-time, daytime, and activity symptom scores, and short-acting beta2-agonist use, were significantly reduced for patients reviewed more than once. CONCLUSION: There are a large proportion of patients suffering symptoms at rest or on a daily basis. There was a significant reduction in symptom levels and use of reliever medication for patients who were reviewed. A review service implementing the BTS/SIGN guidelines for asthma management would seem to improve patient outcomes.

Deliberate self-harm cases: a primary care perspective.

AIM: To observe case ascertainment and one-year outcome among patients presenting with deliberate self-harm (DSH) in an urban practice. METHOD: In this exploratory study, primary care team members recorded all DSH episodes presenting over six months and then tracked their pattern of care over the next 12 months using practice IT systems, patient records and discussions with staff who were involved with patients meeting inclusion criteria. Interviews were held with primary care team members, secondary care staff and voluntary sector staff. Patients were also offered an interview with the community psychiatric nurse, using local NHS trust global assessment and community department risk assessment tools. Relevant data from these sources were then collated and cross-referenced to identify any patterns. RESULTS: Twenty five patients aged between 15 and 44 (19 females) presented at the practice during the six-month period, 15 had taken a drug overdose, nine had self-cut, and one had involved self-stabbing. Most had a long history of similar episodes and substance use and misuse was almost universal. All patients were still alive after 12 months. Of the 13 patients initially in contact with secondary care services, only one established ongoing care. The remainder had very high use of GP services, often in a chaotic manner. CONCLUSION: DSH could best be regarded as a long-term health condition. Support services and intervention opportunities should be configured from within, not outside, general practice. There should be greater liaison between primary and secondary care and increased support for the primary care team.

A survey of GP attitudes to and experiences of email consultations.

Email is an accepted part of modern communication in business and education. The use of email could benefit communication between patients and healthcare professionals. Use of email within health care has been hampered by concerns about privacy, technical barriers, perceived fear of change and increased workload.Sixty-two general practitioners within Dundee in east Scotland responded to a questionnaire and indicated that they regularly used email for communication within their practices and with outside agencies, but rarely with patients. Many perceived a need to provide an email service for clinical enquiries and repeat prescription requests but felt constrained from doing so by a lack of an accepted system and workload concerns.

Email consultations in general practice.

BACKGROUND: Email is an established method of communication in business, leisure and education but not yet health care. AIM: To evaluate an email service enabling communication between patients and their general practice regarding repeat prescriptions, appointment booking and clinical enquiries. DESIGN: Qualitative analysis of interactions and an electronic user survey. SETTING: An urban practice in Dundee, Scotland. PARTICIPANTS: 150 patients aged 24 to 85. METHODS: We set up a practice facility to allow our patients to use email to book appointments, order repeat prescriptions and consult their general practitioner (GP). RESULTS: Patient satisfaction with the service was very high. Patients specifically commended the practice for setting up a facility to allow communication outside standard working hours and for the ease of ordering repeat prescriptions. Patients were pleased to have a means of seeking their doctor's comment or opinion without bothering him or her by making and attending a formal face-to-face consultation. Email dialogue was polite, factual, but less formal than standard letters. Staff did not experience any perceptible rise in workload. CONCLUSIONS: Use of an email consultation facility worked well within an urban practice, was deemed helpful by patients, and resulted in no apparent increase in GP workload. Our results suggest that there may be an unmet need amongst patients for clinical email services, and that such services may have positive outcomes for patients and practices.