Computerised Guidelines Show No Effect on Asthma and Angina Management

Computerised, evidence-based guidelines showed no effect on the management of adult asthma and angina patients in primary care, according to a study conducted in 60 general practices in north east England.

The study reported in the British Medical Journal was conducted by researchers from Newcastle, Aberdeen and City Universities. It was a pragmatic cluster randomised controlled trial designed to measure the effect of using computerised decision support to implement clinical guidelines for asthma and angina management in primary care.

The researchers write, “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.”

They conclude that the lack of an effect from the computerised guidelines was probably due to the low level of software use. This was despite the software being optimised as far as technically possible and the GP practices being chosen because their computer systems were used extensively.

“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,” they write.

The researchers say that although an increasing number of studies show that computerised decision support systems can function in a variety of circumstances, the challenge still remains to show how far this is possible, desirable or efficient.