Eccles M et al. 2002 "Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial."
Reference
Eccles M, McColl E, Steen N, et al. Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial. Br Med J 2002;325(7370):941-944.
Abstract
"Objective: To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care.
Design: A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design.
Setting: 60 general practices in north east England.
Participants: General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma.
Main outcome measures: Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures.
Results: The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low.
Conclusions: No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care. This was probably due to low levels of use of the software, despite the system being optimised as far as was technically possible. Even if the technical problems of producing a system that fully supports the management of chronic disease were solved, there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex, multiple conditions."
Design: A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design.
Setting: 60 general practices in north east England.
Participants: General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma.
Main outcome measures: Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures.
Results: The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low.
Conclusions: No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care. This was probably due to low levels of use of the software, despite the system being optimised as far as was technically possible. Even if the technical problems of producing a system that fully supports the management of chronic disease were solved, there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex, multiple conditions."
Objective
"To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care."
Tools Used
Type Clinic
Primary care
Size
Small and/or medium
Other Information
The study involved "60 general practices in northeast England," each with two or more practitioners.
Type of Health IT
Decision support system
Type of Health IT Functions
"The system anticipated clinician's requirements by using information contained within a patient's computerised record to trigger the guideline and present patient scenarios -- for example, for asthma, review of stable patient or acute exacerbation. Based on the chosen scenario, the system offered suggestions for management (including prescribing) informed by the content of the patient's record and requested the entry of relevant information, which was then stored in the patient's record."
Context or other IT in place
The practices in the study used as an electronic medical record (EMR) one of "two of the most widely used practice computer systems in the United Kingdom." At least half of the physicians in each practice used an electronic system "to view clinical data
Workflow-Related Findings
"No significant effects were found of the computerised decision support system on consultation rates, any aspect of the process of care for patients with angina or asthma...or prescription of any category of drugs."
For both of the two computer systems used in the study, most practitioners rarely used the system, if ever. When the system was triggered they did not go beyond the first screen.
"Patients could present with any clinical problem such as arthritits or depression, and despite having asthma or angina, might not wish to discuss this, even though the computerised system might suggest this was appropriate."
Study Design
Randomized controlled trial (RCT)
Study Participants
The study participants included "[g]eneral practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma."