cost-effective brand of medication. The
targeted savings were considered feasible if 90% of the country’s GPs would
adopt the system and follow the recommended treatments in more than 80%
of their cases.
To make the system as widely available as possible, the Ministry initiated
a large-scale implementation campaign, including instruction videos,
booklets, and posters, aiming to educate the country’s 8,200 GPs as to how
to install and use the system.
Six months following implementation, approximately 50% of surveyed
GPs had installed the system, with 50%
of this group consulting it at least once
a day. However, consulting the system
does not necessarily mean a GP would
follow its recommendations.
Data was based on our observation
of GPs using the system; interviewing
50 of them, along with eight other actors from the implementation team,
the Ministry, and health-insurance
companies, and reviewing the relevant
implementation plans, user manuals,
and evaluation studies. We then categorized the interviewed GPs and other
relevant stakeholders according to our
model (see Figure 2).
Resisting but high usage. Resisting-but-high-usage GPs perceived problems
and disadvantages but still used the system (ambivalent behavior). Some were
required to do so by their group-practice
managers or colleagues. Typically, they
used the system but did not follow its
recommendations for several reasons:
lack of trust in the recommendations;
disagreement with recommended
quantity or quality of drugs; or limiting
access to obtaining a second opinion
after a patient had left the consultation
room. The two groups in this quadrant
were the 18% of the 50 interviewed GPs
who used the system to obtain a second opinion and the 20% who did not
trust or agree with the system’s recommendations. These groups differed in
that GPs from the 18% group used the
system to gain confidence determining
their patients’ prescriptions, though
such use did not coincide with the Ministry’s publicly stated intentions.
Supporting and high usage. Only
12% of the 50 interviewed GPs said the
EPS was easy to use and useful in pro-
ducing quality output when consult-
ing patients. These supporting-and-
high-usage GPs said the system saved
them time so they could focus more
on the consulting process itself, mak-
ing consultation more efficient. For ex-
ample, rather than abruptly conclude a
10-minute consultation with a patient,
they could suggest the session was
about to end by inserting a special code
into the system. These GPs empha-
sized their prescriptions had become
more consistent with those of their col-
leagues. The result was less time and
money spent per patient in group prac-
tices and by GPs working part time, as
well as by better management of pa-
tients’ medical data and archives.
figure 2. Result of data analysis.
( 1) Resisting but high usage
( 2) supporting and high usage
20% of GPs did not
trust or agree with
18% of the GPs used
the system to obtain
a second opinion.
12% of GPs used the
system as intended.
( 4) Resisting and No/Low usage
( 3) supporting but No/Low usage
36% of the GPs did
not install the system
and were against use.
14% of the GPs did
not install but
perceived it useful.
for other actors