PubMed · 10243116
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G Goldhaber. 1979-06-30. On communication.. https://pubmed.ncbi.nlm.nih.gov/10243116/
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We wanted to investigate what advice UK homeopaths, chiropractors and general practitioners give on measles, mumps and rubella vaccination programme (MMR) vaccination via the Internet. Online referral directories listing e-mail addresses of UK homeopaths, chiropractors and general practitioners and private websites were visited. All addresses thus located received a letter of a (fictitious) patient asking for advice about the MMR vaccination. After sending a follow-up letter explaining the nature and aim of this project and offering the option of withdrawal, 26% of all respondents withdrew their answers. Homeopaths yielded a final response rate (53%, n = 77) compared to chiropractors (32%, n = 16). GPs unanimously refused to give advice over the Internet. No homeopath and only one chiropractor advised in favour of the MMR vaccination. Two homeopaths and three chiropractors indirectly advised in favour of MMR. More chiropractors than homeopaths displayed a positive attitude towards the MMR vaccination. Some complementary and alternative medicine (CAM) providers have a negative attitude towards immunisation and means of changing this should be considered.
OBJECTIVE: To understand the factors influencing the adoption of a computerised clinical decision support system for two chronic diseases in general practice. DESIGN: Practice based, longitudinal, qualitative interview study. SETTING: Five general practices in north east England. PARTICIPANTS: 13 respondents (two practice managers, three nurses, and eight general practitioners) gave a total of 19 semistructured interviews. 40 people in practices included in the randomised controlled trial (34 doctors, three nurses) and interview study (three doctors, one previously interviewed) gave feedback. RESULTS: Negative comments about the decision support system significantly outweighed the positive or neutral comments. Three main areas of concern among clinicians emerged: timing of the guideline trigger, ease of use of the system, and helpfulness of the content. Respondents did not feel that the system fitted well within the general practice context. Experience of "on-demand" information sources, which were generally more positively viewed, informed the comments about the system. Some general practitioners suggested that nurses might find the guideline content more clinically useful and might be more prepared to use a computerised decision support system, but lack of feedback from nurses who had experienced the system limited the ability to assess this. CONCLUSIONS: Significant barriers exist to the use of complex clinical decision support systems for chronic disease by general practitioners. Key issues include the relevance and accuracy of messages and the flexibility to respond to other factors influencing decision making in primary care.
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