A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97
BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7281.279 (Published 03 February 2001) Cite this as: BMJ 2001;322:279
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In their review, Mitchell and Sullivan found no evidence that
computers in consultations resulted in negative effects on those patient
outcomes evaluated, and concluded that doctors and patients were generally
positive about use of computers.1
Computers in the general practice consultation can improve the
quality of medical care in some cases.2 Benefits have been shown in
disease prevention with an improvement in immunisation rates by up to 18%
and other preventive tasks by up to 50%,3 in disease management with more
appropriate dosing for drugs with a narrow therapeutic range,4 and in the
management of chronic physical illness where there is a clear consensus
regarding treatment protocols.5;6
However, their use is associated with significant detrimental effects
on the consultation. Consultation time is increased by their use and there
is no appreciable benefit for patient satisfaction.3 Both practitioners'
conduct and the disclosure of information by the patient are adversely
affected,4 and many patients are concerned about confidentiality.5 The
current systems are not well suited to the wide variety of
undifferentiated problems that present in general practice, and may
prevent the doctor from developing the empathic relationship which is
necessary in these types of consultation. This makes evaluating the impact
of computers in consultations particularly important.6
Work is still needed to ensure that the computerisation of the
consultation is not detrimental to the quality of the relationship between
the doctor and patient in the consultation.
Reference List
1. Mitchell, E., Sullivan, F. A descriptive feast but an evaluative
famine: systematic review of published articles on primary care computing
during 1980-97. BMJ 2001;322:279-282.
2. Delaney BC, Fitzmaurice DA, Riaz A, Hobbs FDR. Can computerised
decision support systems deliver improved quality in primary care? BMJ
1999;319:1281.
3. Sullivan F,.Mitchell E. Has general practitioner computing made a
difference to patient care? A systematic review of published reports. BMJ
1995;311:848-52.
4. Greatbatch D, Heath C, Campion P, Luff P. How do desk-top
computers affect the doctor-patient interaction? Fam Pract 1995;12:32-6.
5. Ridsdale L,.Hudd S. What do patients want and not want to see
about themselves on the computer screen: a qualitative study. Scand J Prim
Health Care 1997;15:180-3.
6. Feinstein AR. The need for humanised science in evaluating
medication. Lancet 1972;ii :421-3.
Competing interests: No competing interests
Primary Care Skills and Computing
Mitchell and Sullivan’s comprehensive review on primary care
computing1 raised the issue that practitioners perceived their training in
computer use as being poor. They also noted that computer literacy should
be made a component of ongoing medical education.
While agreeing with this statement, however we feel that there is
more to this issue than just being comfortable using a computer. There is
little doubt that most practitioners have some basic knowledge of
computing, but are they information literate, can they search Medline
efficiently, negotiate the Cochrane database, navigate a reliable health
portal and evaluate useful content on behalf of their patients?
A study by Young and Ward2 on general practitioners’ use of evidence
databases showed that 22% were aware of the Cochrane database, 6% had
access to it and only 4% had ever used it. Another study by Ely, Levy and
Hartz3 shows that only 26% of family physicians had computers in their
offices and that the majority turned to books when faced with questions
about patient care. Hence, research suggests that general practitioners
may be reluctant to embrace information technology. Perhaps one of the
reasons to this reluctance is due to technical issues rather than issue of
skill.
The best method for information retrieval from the web is not
currently known. In a study by Graber, Bergus and York4 it was found that
medicine-specific search engines on the web fare poorly in answering
clinical questions when compared with general search engines. Furthermore,
a review by Hersh and Hickam5 suggests that current information retrieval
systems are too slow to allow busy clinicians to address the myriad
questions that arise in clinical practice. Hence how can one integrate
computers into clinical practice if the tools we use are worn and dated?
The younger generation of medical practitioners and medical students
seem to have more confidence and skill in computer and medical informatic
use6. Combined with advances in user-friendly technology perhaps the
problem of information illiteracy will no longer be an issue for future
generations.
References:
1. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine:
systematic review of published articles on primary care computing during
1980-97. BMJ 2001; 322: 279-82.
2. Young JM, Ward JE. General practitioners’ use of evidence databases.
MJA 1999; 170: 56-58.
3. Ely JW, Levy BT, Hartz A. What clinical information resources are
available in family physicians’ offices?. Journal of family practice 1999;
48(2): 135-139.
4. Graber MA, Bergus GR, York C. Using the World Wide Web to answer
clinical questions: how efficient are different methods of information
retrieval?. Journal of family practice 1999; 48(7): 520-524.
5. Hersh WR, Hickman DH. How well do physicians use electronic information
retrieval systems? A framework for investigation and systematic review.
JAMA 1998; 280(15): 1347-1352.
6. Jerant AF, Lloyd AJ. Applied medical informatics and computing skills
of students, residents, and faculty. Family medicine 2000; 32(4): 267-272.
Competing interests: No competing interests