Walton RT et al. 1997 "Evaluation of computer support for prescribing (CAPSULE) using simulated cases."
Reference
Walton RT, Gierl C, Yudkin P, et al. Evaluation of computer support for prescribing (CAPSULE) using simulated cases. Br Med J 1997;315(7111):791-795.
Abstract
"Objective: To evaluate the potential effect of computer support on general practitioners' prescribing, and to compare the effectiveness of three different support levels.
Design: Crossover experiment with balanced block design.
Subjects: Random sample of 50 general practitioners (42 agreed to participate) from 165 in a geographically defined area of Oxfordshire.
Interventions: Doctors prescribed for 36 simulated cases constructed from real consultations. Levels of computer support were control (alphabetical list of drugs), limited support (list of preferred drugs), and full support (the same list with explanations available for suggestions).
Main outcome measures: Percentage of cases where doctors ignored a cheaper, equally effective drug; prescribing score (a measure of how closely prescriptions matched expert recommendations); interview to elicit doctors' views of support system.
Results: Computer support significantly improved the quality of prescribing. Doctors ignored a cheaper, equally effective drug in a median 50% (range 25%-75%) of control cases, compared with 36% (8-67%) with limited support and 35% (0-67%) with full support (P<0.001). The median prescribing score rose from 6.0 units (4.2-7.0) with control support to 6.8 (5.8-7.7) and 6.7 (5.6 to 7.8) with limited and full support (P<0.001). Of 41 doctors, 36 (88%) found the system easy to use and 24 (59%) said they would be likely to use it in practice.
Conclusions: Computer support improved compliance with prescribing guidelines, reducing the occasions when doctors ignored a cheaper, equally effective drug. The system was easy to operate, and most participating doctors would be likely to use it in practice"
Design: Crossover experiment with balanced block design.
Subjects: Random sample of 50 general practitioners (42 agreed to participate) from 165 in a geographically defined area of Oxfordshire.
Interventions: Doctors prescribed for 36 simulated cases constructed from real consultations. Levels of computer support were control (alphabetical list of drugs), limited support (list of preferred drugs), and full support (the same list with explanations available for suggestions).
Main outcome measures: Percentage of cases where doctors ignored a cheaper, equally effective drug; prescribing score (a measure of how closely prescriptions matched expert recommendations); interview to elicit doctors' views of support system.
Results: Computer support significantly improved the quality of prescribing. Doctors ignored a cheaper, equally effective drug in a median 50% (range 25%-75%) of control cases, compared with 36% (8-67%) with limited support and 35% (0-67%) with full support (P<0.001). The median prescribing score rose from 6.0 units (4.2-7.0) with control support to 6.8 (5.8-7.7) and 6.7 (5.6 to 7.8) with limited and full support (P<0.001). Of 41 doctors, 36 (88%) found the system easy to use and 24 (59%) said they would be likely to use it in practice.
Conclusions: Computer support improved compliance with prescribing guidelines, reducing the occasions when doctors ignored a cheaper, equally effective drug. The system was easy to operate, and most participating doctors would be likely to use it in practice"
Objective
"To evaluate the potential effect of computer support on general practitioners' prescribing, and to compare the effectiveness of three different support levels" on general practitioners in the outpatient setting.
Tools Used
Type Clinic
Primary care
Type Specific
Family practice
Size
Small and/or medium
Type of Health IT
Decision support system
Type of Health IT Functions
"The top half of the computer screen showed a patient's medical history, social history, presenting problem and current treatment... The bottom half of the screen contained either an alphabetical drug list or the computer support system's suggestions for treatment. In the limited support mode the pick list of drugs was ordered with the most favoured drug at the top. With full support, the same list was given but the doctor had the option of inspecting the computer's reasons for suggesting the drug."
Workflow-Related Findings
88 percent of physicians felt the system was easy to use and 54 percent found the system "helpful in making therapeutic choices."
59 percent "said that they would find the prescribing support useful if it was integrated with their practice computer."
40 percent of physicians did not examine the provided explanation for the drug suggestions.
With computerized support, physicians altered their prescribing patterns and ignored the cheaper, equally effective medication 36 percent of the time as opposed to 50 percent without support.
Study Design
Only postintervention with intervention and control groups
Study Participants
The study had a randomly selected sample of 50 general practitioners out of the 165 practicing in the Oxford District, England at the time. Of the 50 selected, 42 doctors agreed to participate.