BMJ 2003;326:314 ( 8 February )

Primary care

Practice based, longitudinal, qualitative interview study of computerised evidence based guidelines in primary care

Nikki Rousseau, research associate, ^a Elaine McColl, national primary care career scientist, ^a John Newton, principal lecturer, ^b Jeremy Grimshaw, professor of health services research, ^c Martin Eccles, professor of clinical effectiveness. ^a

^a Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA, ^b Department of Sociology, University of Northumbria, Newcastle upon Tyne, ^c Health Services Research Unit, University of Aberdeen, Aberdeen

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

Objective: To understand the factors influencing the adoption of a computerised clinical decision support system for two chronic diseases in general practice.
Design: Practice based, longitudinal, qualitative interview study.
Setting: Five general practices in north east England.
Participants: 13 respondents (two practice managers, three nurses, and eight general practitioners) gave a total of 19 semistructured interviews. 40 people in practices included in the randomised controlled trial (34 doctors, three nurses) and interview study (three doctors, one previously interviewed) gave feedback.
Results: Negative comments about the decision support system significantly outweighed the positive or neutral comments. Three main areas of concern among clinicians emerged: timing of the guideline trigger, ease of use of the system, and helpfulness of the content. Respondents did not feel that the system fitted well within the general practice context. Experience of "on-demand" information sources, which were generally more positively viewed, informed the comments about the system. Some general practitioners suggested that nurses might find the guideline content more clinically useful and might be more prepared to use a computerised decision support system, but lack of feedback from nurses who had experienced the system limited the ability to assess this.
Conclusions: Significant barriers exist to the use of complex clinical decision support systems for chronic disease by general practitioners. Key issues include the relevance and accuracy of messages and the flexibility to respond to other factors influencing decision making in primary care.

What is already known on this topic Randomised controlled trials of complex computerised decision support systems have found low rates of use and no effects on process and outcomes of care What this study adds Clinicians found a computerised decision support system for chronic disease in general practice to be difficult to use and unhelpful clinically It did not fit well into a general practice consultation and compared unfavourably with "on-demand" information "Active" decision support can make clinicians aware of gaps between their own practice and "best" practice, but computer prompts need to be relevant and accurate

---

© 2003 BMJ Publishing Group Ltd
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

Related Article

Decision support systems disrupt GPs' workflow
BMJ 2003 326: 0. [Full Text]

This article has been cited by other articles:

• Schnipper, J. L., Linder, J. A., Palchuk, M. B., Einbinder, J. S., Li, Q., Postilnik, A., Middleton, B. (2008). "Smart Forms" in an Electronic Medical Record: Documentation-based Clinical Decision Support to Improve Disease Management. J. Am. Med. Inform. Assoc. 15: 513-523 [Abstract] [Full text]  
• Varonen, H., Kortteisto, T., Kaila, M., for the EBMeDS Study Group, (2008). What may help or hinder the implementation of computerized decision support systems (CDSSs): a focus group study with physicians. Fam Pract 25: 162-167 [Abstract] [Full text]  
• Klebe, B., Farmer, C., Cooley, R., de Lusignan, S., Middleton, R., O'Donoghue, D., New, J., Stevens, P. (2007). Kidney disease management in UK primary care: guidelines, incentives and Information Technology. Fam Pract 24: 330-335 [Abstract] [Full text]  
• Feifer, C., Nemeth, L., Nietert, P. J., Wessell, A. M., Jenkins, R. G., Roylance, L., Ornstein, S. M. (2007). Different Paths to High-Quality Care: Three Archetypes of Top-Performing Practice Sites. Ann Fam Med 5: 233-241 [Abstract] [Full text]  
• Scott, I. (2007). The evolving science of translating research evidence into clinical practice. Evid. Based Med. 12: 4-7 [Full text]  
• Wilson, B. J, Torrance, N., Mollison, J., Watson, M S., Douglas, A., Miedzybrodzka, Z., Gordon, R., Wordsworth, S., Campbell, M., Haites, N., Grant, A. (2006). Cluster randomized trial of a multifaceted primary care decision-support intervention for inherited breast cancer risk. Fam Pract 23: 537-544 [Abstract] [Full text]  
• Kattan, M., Crain, E. F., Steinbach, S., Visness, C. M., Walter, M., Stout, J. W., Evans, R. III, Smartt, E., Gruchalla, R. S., Morgan, W. J., O'Connor, G. T., Mitchell, H. E. (2006). A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma.. Pediatrics 117: e1095-e1103 [Abstract] [Full text]  
• Feifer, C., Ornstein, S. M., Jenkins, R. G., Wessell, A., Corley, S. T., Nemeth, L. S., Roylance, L., Nietert, P. J., Liszka, H. (2006). The logic behind a multimethod intervention to improve adherence to clinical practice guidelines in a nationwide network of primary care practices.. Eval Health Prof 29: 65-88 [Abstract]  
• May, C. (2005). Chronic illness and intractability: professional--patient interactions in primary care. Chronic Illness 1: 15-20  
• McMullin, S. T., Lonergan, T. P., Rynearson, C. S., Doerr, T. D., Veregge, P. A., Scanlan, E. S. (2004). Impact of an Evidence-Based Computerized Decision Support System on Primary Care Prescription Costs. Ann Fam Med 2: 494-498 [Abstract] [Full text]  
• Walsh, S. H (2004). The clinician's perspective on electronic health records and how they can affect patient care. BMJ 328: 1184-1187 [Full text]  
• Butzlaff, M, Vollmar, H., Floer, B, Koneczny, N, Isfort, J, Lange, S (2004). Learning with computerized guidelines in general practice?: A randomized controlled trial. Fam Pract 21: 183-188 [Abstract] [Full text]  
• Bates, D. W., Kuperman, G. J., Wang, S., Gandhi, T., Kittler, A., Volk, L., Spurr, C., Khorasani, R., Tanasijevic, M., Middleton, B. (2003). Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality. J. Am. Med. Inform. Assoc. 10: 523-530 [Abstract] [Full text]  
• (2003). OTHER ARTICLES NOTED (24 Jan 03 to 18 Apr 03). Evid. Based Nurs. 6: e1-12 [Full text]  
• de Lusignan, S. (2003). What Is Primary Care Informatics?. J. Am. Med. Inform. Assoc. 10: 304-309 [Abstract] [Full text]  
• Prince, C. B (2003). Computerised evidence based guidelines in primary care: Interactive decision support is here and essential for 21st century primary care. BMJ 326: 1087-1087 [Full text]  
• Lipman, T. (2003). Computerised evidence based guidelines in primary care: Computerised decision support and reflection in action. BMJ 326: 1087-1088 [Full text]  

Rapid Responses:

Read all Rapid Responses

Computerised decision support and reflection in action

Toby Lipman
bmj.com, 10 Feb 2003 [Full text]

Similar findings

Michael A Krall MD MS, et al.
bmj.com, 10 Feb 2003 [Full text]

User friendly guidelines - is the GP software to blame or are GPs just prejudiced?

Kenneth M Holton
bmj.com, 13 Feb 2003 [Full text]

Interactive Decision Support is alive and well and essential for 21st Century Primary Care

Clive B Prince, et al.
bmj.com, 14 Feb 2003 [Full text]