RESUMEN
OBJECTIVES: Variation exists in the capabilities of electronic healthcare records (EHRs) systems and the frequency of their use by primary care physicians (PCPs) from different settings. We aimed to examine the factors associated with everyday EHRs use by PCPs, characterise the EHRs features available to PCPs, and to identify the impact of practice settings on feature availability. STUDY DESIGN: Cross-sectional study. METHODS: PCPs from 20 countries completed cross-sectional online survey between June and September 2020. Responses which reported frequency of EHRs use were retained. Associations between everyday EHRs use and PCP and practice factors (country, urbanicity, and digital maturity) were explored using multivariable logistic regression analyses. The effect of practice factors on the variation in availability of ten EHRs features was estimated using Cramer's V. RESULTS: Responses from 1520 out of 1605 PCPs surveyed (94·7%) were retained. Everyday EHRs use was reported by 91·2% of PCPs. Everyday EHRs use was associated with PCPs working >28 h per week, having more years of experience using EHRs, country of employment, and higher digital maturity. EHRs features concerning entering, and retrieving data were available to most PCPs. Few PCPs reported having access to tools for 'interactive patient education' (37·3%) or 'home monitoring and self-testing of chronic conditions' (34·3%). Country of practice was associated with availability of all EHRs features (Cramer's V range: 0·2-0·6), particularly with availability of tools enabling patient EHRs access (Cramer's V: 0·6, P < 0.0001). Greater feature availability of EHRs features was observed with greater digital maturity. CONCLUSIONS: EHRs features intended for patient use were uncommon across countries and levels of digital maturity. Systems-level research is necessary to identify the country-specific barriers impeding the implementation of EHRs features in primary care, particularly of EHRs features enabling patient interaction with EHRs, to develop strategies to improve systems-wide EHRs use.
Asunto(s)
Registros Electrónicos de Salud , Atención Primaria de Salud , Registros Electrónicos de Salud/estadística & datos numéricos , Estudios Transversales , Humanos , Atención Primaria de Salud/estadística & datos numéricos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Médicos de Atención Primaria/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
The hydrostatic pressure stimulation of an appropriately cell-seeded porous scaffold within a bioreactor is a promising method for engineering bone tissue external to the body. We propose a mathematical model, and employ a suite of candidate constitutive laws, to qualitatively describe the effect of applied hydrostatic pressure on the quantity of minerals deposited in such an experimental setup. By comparing data from numerical simulations with experimental observations under a number of stimulation protocols, we suggest that the response of bone cells to an applied pressure requires consideration of two components; (i) a component describing the cell memory of the applied stimulation, and (ii) a recovery component, capturing the time cells require to recover from high rates of mineralisation.