General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

Abstract

Objective The Scottish Care Information -Diabetes Collaboration (SCI-DC) developed a computer-based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. Method We conducted an exploratory study using qualitative methods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care in NHS Lothian participated. Results Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. Conclusions Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption.

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“…Similarly, telenursing such as in [22,25] is used for collaboration between healthcare providers in treating remote patients. Different computer applications and communication networks such as [23,24,27,30,[33][34][35] are used for collaboration and information sharing.…”

“…Similarly, an exploratory study [27] based on the semi-structured interview was conducted in 2010 in the UK to understand primary care practitioners' views towards screening for diabetic foot disease. Seven nurses and six general practitioners participated in the study.…”

Implementing an integrated computerised information system about foot problems in diabetes is not enough to ensure adoption. Commentary on: General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease: implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

“…8 From 2004 onwards GPs in England have been paid specifically to undertake a foot examination, meaning some 80-90% of patients with diabetes undergo foot screening every year. 3 Despite this, according to national diabetes audit data, there has been no reduction in amputation rates or evidence to suggest that there has been a reduction in ulceration rates since the introduction of mandatory foot screening. 3,9 Incentives focussing on process rather than outcome are perverse Whilst financial incentives are an effective way to implement policy they can provide perverse incentives with prompts and reminders focussed on the process rather than the outcome measure.…”

“…3 Despite this, according to national diabetes audit data, there has been no reduction in amputation rates or evidence to suggest that there has been a reduction in ulceration rates since the introduction of mandatory foot screening. 3,9 Incentives focussing on process rather than outcome are perverse Whilst financial incentives are an effective way to implement policy they can provide perverse incentives with prompts and reminders focussed on the process rather than the outcome measure. 10 GPs are neither obliged to act upon the findings of a foot screen nor train screeners (usually practice nurses) to perform a correct examination.…”

“…3 The main reason cited for poor use of the SCI-DC was its failure to integrate into existing primary care IT systems.…”