Communications - November 2011

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.