Intended for healthcare professionals

Primary Care

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

BMJ 2003; 326 doi: (Published 08 February 2003) Cite this as: BMJ 2003;326:314
  1. Nikki Rousseau, research associatea,
  2. Elaine McColl, national primary care career scientista,
  3. John Newton, principal lecturerb,
  4. Jeremy Grimshaw, professor of health services researchc,
  5. Martin Eccles (martin.eccles{at}, professor of clinical effectivenessa
  1. a Centre for Health Services Research, University of Newcastle upon Tyne, Newcastle upon Tyne NE2 4AA
  2. b Department of Sociology, University of Northumbria, Newcastle upon Tyne
  3. c Health Services Research Unit, University of Aberdeen, Aberdeen
  1. Correspondence to: M Eccles
  • Accepted 23 December 2002


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

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

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


  • Funding NHS R&D programme “Methods to promote the uptake of research findings”; additional funding from EMIS Computing and the Department of Health for England and Wales. The Health Services Research Unit, University of Aberdeen, is funded by the Chief Scientist Office of the Scottish Executive Health Department. EMcC and NR are funded by the UK NHS primary care development programme. The Centre for Health Services Research, University of Newcastle upon Tyne and the Health Services Research Unit, University of Aberdeen are part of the UK MRC Health Services Research Collaboration. The views expressed are those of the authors and not necessarily those of the funding bodies.

  • Competing interests None declared.

  • Accepted 23 December 2002
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