Has general practitioner computing made a difference to patient care? A systematic review of published reports

Abstract

Objective : To review findings from studies of the influence of desktop computers on primary care consultations. Design : Systematic review of world reports from 1984 to 1994. Setting : The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. Subjects : 30 papers met the inclusion criteria and were included for detailed review. Interventions : A validated scheme for assessing methodological adequacy was used to score each paper. Main outcome measures : Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. Results : Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and “medical” content of consultations increased at the expense of a reduction in patient initiated and “social” content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). Conclusions : Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations.