Effects of using a computer in a doctor's office on patient attitudes toward using computerized prompts in routine care

Background: We undertook this investigation to understand the effect of using a computer in a primary care setting on attitudes toward using computers to improve health services delivery. Methods: In this analysis, we compared the acceptability data from the group of primary care patients from 10 community-based practices who did not use a computer program, and answered the questions hypothetically, with data from a group of patients who actually used a program such as one proposed in the survey taken by the first group of patients. Attitudes toward three uses of the program, screening, counseling and changing treatments were measured, as well as attitudes toward specific aspects of the program, such as security. Results: The great majority of patients who used the program believed that the program was not too long (80.1%), was easy to use (82.3%) and that the questions were not hard to answer (75.7%). Also, on average only 20% of patients had concerns about the privacy and confidentiality of using the program. Patients who had used the computer program were significantly less likely to favor its use for screening (odds ratio (OR) = 0.09, 95% confidence interval (0) = 0.04-0.19], counseling [OR = 0. 13 (95% CI = 0.05-0.31)] and changing treatments for chronic conditions, such as hypertension [OR = 0. 12 (95% CI = 0.07-0.23)]. Patients who felt that the computer took too long to use were less likely to favor its use for each of the three uses. Conclusions: Despite acceptability ratings that were high and consistent with ratings observed in other studies, exposure to the program significantly diminished support for using it in routine care. These findings highlight the need for measuring overall program acceptability in the context of a realistic use scenario and for correlating overall acceptability with acceptability of individual program components and attitudes, as a means for identifying opportunities for program improvement. (c) 2005 Elsevier Ireland Ltd. All rights reserved.