The impact of low-value prescriptive tasks and of electronic medical record (EMR) software crashes in Portuguese GPs’ clinical time occupation and misuse- an exploratory study.

Mariana Ribeiro, Ana Resende Mateus

Keywords: low value tasks; practice management; general practice

Background:

GP’s work time should be reserved to cost-beneficial tasks. Repeated prescriptions requiring low level of clinical judgment and daily crashes in software are a serious issue in the Portuguese NHS, as well as GP non-quantified extra work time and burnout.

Research questions:

To assess the total weekly work time from Portuguese GPs, and the time spent in low-value tasks and software failures.

Method:

Study design: Cross-sectional, descriptive. Setting: multicentric. Population: NHS GP (N=5610). Sampling: convenience (n=263). Data collection: self-monitoring of a week's working times; self-administered anonymous questionnaire, regarding demographic variables, practice setting description, and time spent in specific tasks, or lost by GP inactivity due to software crashes. Statistics: central tendency and dispersion measures.

Results:

Response rate: 31.5% (n=83): 57.8% female; 51.8% from the North region; average experience of 12.3 years as GP (STD= 10.63). Average patient list=1755 (STD=164,1). During the week of observation, the average total working time was 45.3 hours, with a non-recognised extra work of 6.27 hours/week. Filling chronic prescriptions=137 min (33% previous ones, lost by the patients), renewing chronic rehabilitation orders=33min; transcribing tests asked by other doctors= 32min. 73 min were lost due to EMR software crashes, whose compensation time was reported by 83% to be taken away from personal rest. About 4.6 hours/week (73.5% of the extra work time) were occupied with low-value tasks or forced stops in activity due to software problems.

Conclusions:

A low response rate and a small non-probabilistic sample should be regarded as limitations. Despite this, it seems to be quantified for the first time in Portugal an inefficient use of GPs time; areas requiring organizational improvements were pointed out, addressing access and reduction of GP burnout risk.

Points for discussion:

Expansion of the study

Improvement of response rate

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