1Electronic Services in Primary Care 1Introduction

Название1Electronic Services in Primary Care 1Introduction
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Section 1


1.1 Introduction 3

1.2 Rationale for the study 4



2.1 Introduction 7

2.2 Drafting and piloting of the study materials 8

2.3 Stated preference analysis method 11

2.4 Initial proposals on format of stated preference experiment 12

2.5 Detailed stated preference design 14

2.6 Theory of individual choice 18

2.7 Specification of the utility function 20

2.8 Pilot survey 21

2.9 Data processing 25

2.10 Characteristics of the sample 25

2.11 Basic field model 27

2.12 Testing for scale differences 29

2.13 Field model with segmentation 30

2.14 Basic field model corrected for repeated observations 38

2.15 Marginal rates of substitution 39

2.16 Prevalence of taste variation 40

2.17 Principal findings 41

2.18 Discussion 43

Section 3


3.1 Introduction 45

3.2 Background and methods 46

3.3 Social networks and small worlds 47

3.4 Representing mail networks 50

3.5 Data analysis 52

3.6 Visualisation techniques 54

3.7 Results 56

3.8 Variation in link definition 62

3.9 Simulation 65

3.10 Implementation of the model 66

3.11 Simulation runs (version 1) 67

3.12 Simulation runs (version 2) 69

3.13 Discussion 71

3.14 Suitability of the approach 72

3.15 Change in working practice? 73

3.16 Implications for the NHS 75

3.17 The effects of agent behaviour 76

3.18 Conclusions 79

References 81

Appendices (A and B) 87

1Electronic Services in Primary Care


The overall aim of this project was to investigate the value of electronic services in primary care. We define electronic services as services which are available via modern electronic networks. Across the Internet these services include Amazon, eBay, MySpace and Facebook. In health care the services include networked radiology services, electronic transfer of prescribing data and shared electronic records. The striking point about this latter list is that these services are still in their infancy. Many hospitals have picture archiving and communication systems (PACS), but few have hospital-wide networks, and hospital-to-primary care communication of images is still the exception rather than the rule. Similarly, the electronic transfer of prescriptions is becoming more widespread, but is still relatively novel. There has been extensive penetration of electronic services across Denmark, but most other countries are in the throes of planning and implementing large scale IT programmes, and not all of them are finding it easy.

The costs of these programmes, and their political sensitivity in some countries, suggest that policies should be based firmly on evidence about the preferences of users and system effectiveness. Yet there is remarkably little evidence available, and major programmes are based on a range of largely unexamined assumptions – that ‘cradle to grave’ electronic patient records are cost-effective, that those records should be available across a whole country or even a whole continent, and so on. Accordingly, we set out to study the value of electronic services in health care, and focused on primary care on the basis that the costs and effects of site-to-site networks would be most readily observable in primary care settings.

The report is presented in two main sections. The first describes a study of the preferences of doctors for Specific features of electronic services, investigated using discrete choice methods. We found that doctors valued speed of response more highly than other service characteristics, followed by service reliability and ease of access. The second section describes the analysis of email traffic in Bradford. Email is a form of communication within health care organisations which reflects the social relationships between the people who work in them. New methods, derived from studies of social networks, were used to investigate the ‘deep structure’ of the email networks in Bradford.

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