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Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial
Open accessAbstract
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.
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“Importantly there is clear evidence that CDSS tools are not always used when available, 15 with up to 96% of alerts being overridden or ignored by physicians.[16][17][18][19]”
From Computerized clinical decision support for prescribing: provision does not guarantee uptake (2010) · cites this paper as [15]
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- *Effect sizes; estimates of ratio of mean number of consultations for participants in practices that received computerised decision support system to mean number of consultations for participants in control practices based on Poisson regression model. †Patients who consulted after intervention and had not had variable recorded anywhere in their clinical record during period before intervention. Primary care page 4 of 7 BMJ VOLUME 325 26 OCTOBER 2002 bmj.com on 17 July 2023 by guest. Protected by copyright. http://www.bmj.com/ BMJ: first published as 10.1136/bmj.325.7370.941 on 26 October 2002. Downloaded from All patients 516 (43); 511 (43) 492 (42); 517 (45) 0.94 (0.67 to 1.33) Patients who consulted 515 (45); 510 (45) 491 (45); 516 (47) 0.94 (0.66 to 1.34) Compliance checked: All patients 426 (36); 442 (37) 446 (38); 471 (41) 0.82 (0.58 to 1.15) Patients who consulted 425 (37); 441 (39) 445 (40); 470 (43) 0.82 (0.58 to 1.16) Inhaler technique assessed: All patients 203 (17); 224 (19) 234 (20); 262 (23) 0.8 (0.5 to 1.28) Patients who consulted 203 (18); 224 (20) 233 (21); 262 (24) 0.81 (0.5 to 1.28) Asthma education, action plan, or both: All patients 79 (7); 60 (5) 108 (9); 78 (7) 0.84 (0.4 to 1.74) Patients who consulted 79 (7); 60 (5) 108 (10); 78 (7) 0.81 (0.39 to 1.67) Smoking status known: All patients 285 (24); 370 (32) 305 (26); 367 (32) 0.97 (0.65 to 1.45) Patients who consulted 285 (25); 369 (33) 303 (28); 367 (33) 0.98 (0.66 to 1.46) Smoking cessation advice or nicotine replacement therapy: All patients 57 (5); 81 (7) 68 (6); 103 (9) 0.75 (0.45 to 1.26) Patients who consulted 57 (5); 81 (8) 68 (6); 103 (9) 0.76 (0.46 to 1.27)
- *Guideline specifically recommended not using these combinations. Table 5 Drugs prescribed for patients with asthma before and after introduction of computerised decision support system. Values are numbers (percentages) unless stated otherwise Computerised system (n=1391) Controls (n=1385) Odds ratio (95% CI) Short acting 2 agonists 1138 (82); 1112 (80) 1160 (84); 1108 (80) 1.04 (0.83 to 1.31) Inhaled corticosteroids 1065 (77); 1001 (72) 1004 (73); 975 (70) 0.95 (0.78 to 1.16) Long acting 2 agonists 181 (13); 198 (14) 164 (12); 183 (13) 0.84 (0.59 to 1.20) Oral steroids 317 (23); 316 (23) 286 (21); 297 (21) 1.0 (0.82 to 1.22) Oral bronchodilators 100 (7); 95 (7) 120 (9); 119 (9) 1.38 (0.56 to 3.39) Primary care page 5 of 7 BMJ VOLUME 325 26 OCTOBER 2002 bmj.com on 17 July 2023 by guest. Protected by copyright. http://www.bmj.com/ BMJ: first published as 10.1136/bmj.325.7370.941 on 26 October 2002. Downloaded from
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“[1] conducted a pragmatic cluster randomized controlled trial of a computerized decision support system to implement clinical guidelines for the management of asthma and angina in adults in primary care.”
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Effecten van implementatie: gecontroleerde evaluaties
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Chakrabarti, B., Sankaranarayanan, R., Hartshorne‐Evans, N., Mclean, L., Pritchard, C., Jones, J., Salla, M., Dowie, L., Cooper, C. B., McKnight, E., et al. (2025) · ERJ Open Research · doi:10.1183/23120541.00669-2025
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“A study by Eccles et al. [65] attributed the lack of noticeable effect of a novel computerized decision support system for asthma and angina management to “low levels of use of the software, despite the system being optimized as far as was technically possible.”
van Wyk, J. T., & van Wijk, M. A. M. (2004) · PubMed
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Metadata
- Authors
- Eccles, M.
- Affiliations
- Newcastle University (GB)
- Corresponding author
- Eccles, M.
- Venue
- BMJ
- Publisher
- BMJ
- Published
- 2002-10-26
- Volume
- 325
- Issue
- 7370
- Pages
- 941-941
- ISSN
- 0007-1447 (ISSN-L)
- 0959-8138
- 1468-5833
- PMC
- PMC130060
- OpenAlex
- W1996469473
- Cited by
- 354
- References
- 24
- Citations by year
- 2026: 3 · 2025: 5 · 2024: 4 · 2023: 3 · 2022: 9 · 2021: 7 · 2020: 7 · 2019: 5 · 2018: 9 · 2017: 7 · 2016: 12 · 2015: 10 · 2014: 14 · 2013: 19 · 2012: 14
- FWCI
- 29.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- BMJ (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Health Professions › General Health Professions › Health Sciences Research and Education
- Keywords
- computerised decision support, clinical guidelines, asthma management, angina management, guideline adherence, primary care, general practitioners, practice nurses, drug prescribing, patient-reported outcomes, chronic disease management
- MeSH terms
- Angina Pectoris, Asthma, Decision Making, Computer-Assisted, Family Practice, Humans, Treatment Outcome, Practice Guidelines as Topic, Evidence-Based Medicine, Guideline Adherence
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