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

doi:10.1136/bmj.325.7370.941

BMJ 2002;325:941 ( 26 October )

Primary care

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

Martin Eccles, professor of clinical effectiveness, ^a Elaine McColl, national primary care career scientist, ^a Nick Steen, statistician, ^a Nikki Rousseau, research associate, ^a Jeremy Grimshaw, professor, ^b David Parkin, professor of health economics, ^c Ian Purves, professor. ^d

^a Centre for Health Services Research, University of Newcastle, Newcastle upon Tyne NE2 4AA, ^b Health Services Research Unit, University of Aberdeen, Aberdeen AB25 2ZD, ^c Department of Economics, City University, London EC1V 0HB, ^d Sowerby Centre for Health Informatics, University of Newcastle, Newcastle upon Tyne NE2 4AB

Correspondence to: M Eccles martin.eccles{at}ncl.ac.uk

Objective: To evaluate the use of a computerised supportsystem for decision making for implementing evidence based clinicalguidelines for the management of asthma and angina in adults inprimarycare.
Design: A before and after pragmatic cluster randomisedcontrolled trial utilising a two by two incomplete blockdesign.
Setting: 60 general practices in north eastEngland.
Participants: General practitioners and practice nursesin the study practices and their patients aged 18 or over withangina orasthma.
Main outcome measures: Adherence to the guidelines, based on reviewof case notes and patient reported generic and condition specificoutcomemeasures.
Results: The computerised decision support system hadno significant effect on consultation rates, process of care measures(including prescribing), or any patient reported outcomes foreither condition. Levels of use of the software werelow.
Conclusions: No effect was found of computerised evidencebased guidelines on the management of asthma or angina in adultsin primary care. This was probably due to low levels of use ofthe software, despite the system being optimised as far as wastechnically possible. Even if the technical problems of producinga system that fully supports the management of chronic diseasewere solved, there remains the challenge of integrating the systemsinto clinical encounters where busy practitioners manage patientswith complex, multipleconditions.

What is already known on this topic
Computerised decision support systems produce improvements in patient care across a range of conditions and settings

Previous evaluations have been undermined by flaws in study design

Few studies have evaluated complex decision support systems for the management of chronic disease

What this study adds
No impact was found of a computerised decision support system delivering evidence based guidelines for chronic diseases on either the process or outcomes of care

It is unclear whether there are benefits from integrating such systems into clinical encounters where busy practitioners manage patients with complex and multiple conditions

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