Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial
Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial
复制标题
DOI：
10.1136/bmj.325.7370.941
复制
发表时间：
2002-10-26
影响因子：
105.7
通讯作者：
Purves, I
中科院分区：
文献类型：
--
作者：
Eccles, M;McColl, E;Purves, I
目的评价计算机化支持系统在实施循证临床指南决策中的应用，以管理初级保健中成人哮喘和心绞痛。设计一项前后实用的分组随机对照试验，采用2 × 2不完全区组设计。在英格兰东北部设置60个全科诊所。参与者为研究实践中的全科医生和实习护士，18岁或以上的心绞痛或哮喘患者。主要结果措施坚持的指南，根据审查的情况下，笔记和病人报告的通用和条件的具体outcome measurements.Results的计算机化的决策支持系统没有显着影响的咨询率，过程中的护理措施（包括处方），或任何病人报告的结果，无论是条件。水平的使用该软件是low.Conclusions没有效果被发现的计算机化的证据为基础的指导方针在初级保健成人哮喘或心绞痛的管理。这可能是由于软件的使用率低，尽管该系统在技术上已尽可能优化。即使生产完全支持慢性病管理的系统的技术问题得到解决，仍然存在将系统集成到临床遭遇中的挑战，在临床遭遇中，忙碌的从业者管理具有复杂、多种病症的患者。
Objective To evaluate the use of a computerised support system for decision making for implementing evidence based clinical guidelines for the management of asthma and angina in adults in primary care.Design A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design.Setting 60 general practices in north east England.Participants General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma.Main outcome measures Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures.Results The computerised decision support system had no significant effect on consultation rates, process of care measures (including prescribing), or any patient reported outcomes for either condition. Levels of use of the software were low.Conclusions No effect was found of computerised evidence based guidelines on the management of asthma or angina in adults in primary care. This was probably due to low levels of use of the software, despite the system being optimised as far as was technically possible. Even if the technical problems of producing a system that fully supports the management of chronic disease were solved, there remains the challenge of integrating the systems into clinical encounters where busy practitioners manage patients with complex, multiple conditions.