A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97

doi:10.1136/bmj.322.7281.279

BMJ 2001;322:279-282 ( 3 February )

Information in practice

A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97

Elizabeth Mitchell, research fellow, ^a Frank Sullivan, professor of R&D in general practice and primary care. ^b

^a Department of General Practice, University of Glasgow, Glasgow G12 0RR, ^b Tayside Centre for General Practice, University of Dundee

Correspondence to: E Mitchell edm1a{at}clinmed.gla.ac.uk

Objectives: To appraise findings from studies examiningthe impact of computers on primary careconsultations.
Design: Systematic review of world literature from1980 to1997.
Data sources: 5475 references were identified from electronicdatabases (Medline, Science Citation Index, Social Sciences CitationIndex, Index of Scientific and Technical Proceedings, Embase,OCLC FirstSearch Proceedings), bibliographies, books, identifiedarticles, and by authors active in the field. 1892 eligible abstractswere independently rated, and 89 studies met the inclusioncriteria.
Main outcome measures: Effect on doctors' performance and patientoutcomes; attitudes towardscomputerisation.
Results: 61 studies examined effects of computers onpractitioners' performance, 17 evaluated their impact on patientoutcome, and 20 studied practitioners' or patients' attitudes.Computer use during consultations lengthened the consultation.Reminder systems for preventive tasks and disease management improvedprocess rates, although some returned to pre-intervention levelswhen reminders were stopped. Use of computers for issuing prescriptionsincreased prescribing of generic drugs, and use of computers fortest ordering led to cost savings and fewer unnecessary tests.There were no negative effects on those patient outcomes evaluated.Doctors and patients were generally positive about use of computers,but issues of concern included their impact on privacy, the doctor-patientrelationship, cost, time, and trainingneeds.
Conclusions: Primary care computing systems can improvepractitioner performance, particularly for health promotion interventions.This may be at the expense of patient initiated activities, makingmany practitioners suspicious of the negative impact on relationshipswith patients. There remains a dearth of evidence evaluating effectson patientoutcomes.

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