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

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.