McCowan C et al. 2001 "Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma."
Reference
McCowan C, Neville RG, Ricketts IW, et al. Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma. Med Inform Internet Med 2001;26(3):191-201.
Abstract
"Primary objective: To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes.
Research design: Randomized controlled trial with practices each reporting on 30 patients with asthma over a 6 month period.
Methods and procedures: 447 patients were randomly selected from practice asthma registers managed by 17 general practices from throughout the UK. Intervention practices used the software during consultations with these patients throughout the study while control practices did not.
Main outcomes and results: Practice consultations, acute exacerbations of asthma, hospital contacts, symptoms on assessment and medication use. A smaller proportion of patients within the intervention group initiated practice consultations for their asthma: 34 (22%) vs. 111 (34%), odds ratio (OR) = 0.59, 95% confidence interval (CI) (0.37-0.95); and suffered acute asthma exacerbations: 12 (8%) vs. 57 (17%), OR = 0.43, 95% CI = 0.21-0.85 six months after the introduction of the computer decision support software. There were no discernable differences in reported symptoms, maintenance prescribing or use of hospital services between the two groups.
Conclusion: The use of computer decision support software that implements guidelines during patient consultations may improve clinical outcomes for patients with asthma."
Research design: Randomized controlled trial with practices each reporting on 30 patients with asthma over a 6 month period.
Methods and procedures: 447 patients were randomly selected from practice asthma registers managed by 17 general practices from throughout the UK. Intervention practices used the software during consultations with these patients throughout the study while control practices did not.
Main outcomes and results: Practice consultations, acute exacerbations of asthma, hospital contacts, symptoms on assessment and medication use. A smaller proportion of patients within the intervention group initiated practice consultations for their asthma: 34 (22%) vs. 111 (34%), odds ratio (OR) = 0.59, 95% confidence interval (CI) (0.37-0.95); and suffered acute asthma exacerbations: 12 (8%) vs. 57 (17%), OR = 0.43, 95% CI = 0.21-0.85 six months after the introduction of the computer decision support software. There were no discernable differences in reported symptoms, maintenance prescribing or use of hospital services between the two groups.
Conclusion: The use of computer decision support software that implements guidelines during patient consultations may improve clinical outcomes for patients with asthma."
Objective
"To investigate whether computer decision support software used in the management of patients with asthma improves clinical outcomes."
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
unknown
Other Information
The study took place in the United Kingdom, and involved a total of 46 general practices across the country.
Type of Health IT
Decision support system
Type of Health IT Functions
The software provided decision-support based on current asthma treatment guidelines, using information entered by the user during an initial consultation. The program provided "non-judgmental feedback and management suggestions," such as "check inhaler technique," "review compliance," or "consider increasing dose of preventer inhaler." The software also included "reminders for further examination during the consultation." Furthermore, the software utilized a database of asthma patients, matching clinic patients to similar patients to predict future morbidity. "A facility to print customized self-management plans and advice sheets for individual patients" was also part of the software.
Context or other IT in place
The context varied across practices.
Workflow-Related Findings
Four intervention practices reported problems in installing the software and withdrew from the study.
Because the software ran independently from other programs in Microsoft Windows, practices already using EMRs would potentially have to perform double documentation when using the software in this study. However, none of the intervention practices that withdrew from the study reported this as a reason for withdrawal.
Users "found the software easy to use and could be run with a patient."
Users indicated that the software "could be used in a consultation lasting 10 minutes or under," and the use of the software "increased consultation times slightly."
"The management recommendations and reminders were popular with the users and were deemed to provide relevant clinical advice. Users also felt the software...contributed to an improvement in the quality of the consultation."
"Clinicians reported that the printed management plans were of use and seemed to be of value to the patients."
Patients in the intervention group were not issued self-management plans or peak-flow meters more frequently. Also, "[t]here were no differences in maintenance prescibing patterns between the two groups."
Study Design
Only postintervention with intervention and control groups
Study Participants
Initially, 46 practices took part in the study, of which 21 were randomized to the intervention group and 25 to the control group. Sixteen intervention and 13 control practices later dropped out, leaving five intervention practices (147 patients) and 12 control practices (330 patients). Of the potential respondents in the intervention practices, 11 nurse practitioners and primary care physicians returned the questionnaire.