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Clinical Trial
. 2002 Oct 26;325(7370):941.
doi: 10.1136/bmj.325.7370.941.

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial

Martin Eccles  1 , Elaine McColl, Nick Steen, Nikki Rousseau, Jeremy Grimshaw, David Parkin, Ian Purves
Affiliations
Clinical Trial

Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial

Martin Eccles et al. BMJ. .

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.

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Figures

Figure 1
Figure 1
Flow of practices through trial
Figure 2
Figure 2
Data collected
Figure 3
Figure 3
Box plot of number of times guidelines were triggered per whole time equivalent general practitioner, and proportion of active interactions that involved going beyond first screen, by month of study and supplier. Lower and upper edges of each box represent the 25th and 75th centile of observed data. The line partitioning box corresponds to median observation. In several instances median observation was zero and is coincident with lower edge of box. Whiskers give range of data
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Comment in

References

    1. Grimshaw J, Freemantle N, Wallace S, Russell I, Hurwitz B, Watt I, et al. Developing and implementing clinical practice guidelines. QHC. 1995;4:55–64. - PMC - PubMed
    1. Friedman CP, Wyatt JC. Evaluation methods in medical informatics. New York: Springer-Verlag; 1997.
    1. Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA. 1998;280:1339–1346. - PubMed
    1. Eccles M, Grimshaw J, Steen N, Parkin D, Purves I, McColl E, et al. The design and analysis of a randomised controlled trial to evaluate computerised decision support in primary care: the COGENT Study. Fam Pract. 2000;17:180–186. - PubMed
    1. Eccles M, McColl E, Steen N, Rousseau N, Grimshaw J, Parkin D. An evaluation of computerised guidelines for the management of two chronic conditions. University of Newcastle: Centre for Health Services Research; 2002.

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