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BMJ. Sep 30, 1995; 311(7009): 848–852.
PMCID: PMC2550856

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


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.

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Selected References

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  • Leaning MS. The new information management and technology strategy of the NHS. BMJ. 1993 Jul 24;307(6898):217–217. [PMC free article] [PubMed]
  • Barnett GO. The application of computer-based medical-record systems in ambulatory practice. N Engl J Med. 1984 Jun 21;310(25):1643–1650. [PubMed]
  • Feinstein AR. The need for humanised science in evaluating medication. Lancet. 1972 Aug 26;2(7774):421–423. [PubMed]
  • Rector AL, Nowlan WA, Kay S. Foundations for an electronic medical record. Methods Inf Med. 1991 Aug;30(3):179–186. [PubMed]
  • Wyatt JC. Clinical data systems, Part 1: Data and medical records. Lancet. 1994 Dec 3;344(8936):1543–1547. [PubMed]
  • Wyatt JC. Clinical data systems, Part 3: Development and evaluation. Lancet. 1994 Dec 17;344(8938):1682–1688. [PubMed]
  • Johnston ME, Langton KB, Haynes RB, Mathieu A. Effects of computer-based clinical decision support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Intern Med. 1994 Jan 15;120(2):135–142. [PubMed]
  • Mugford M, Banfield P, O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ. 1991 Aug 17;303(6799):398–402. [PMC free article] [PubMed]
  • Haynes RB, Walker CJ. Computer-aided quality assurance. A critical appraisal. Arch Intern Med. 1987 Jul;147(7):1297–1301. [PubMed]
  • Grimshaw JM, Russell IT. Effect of clinical guidelines on medical practice: a systematic review of rigorous evaluations. Lancet. 1993 Nov 27;342(8883):1317–1322. [PubMed]
  • Herzmark G, Brownbridge G, Fitter M, Evans A. Consultation use of a computer by general practitioners. J R Coll Gen Pract. 1984 Dec;34(269):649–654. [PMC free article] [PubMed]
  • Pringle M, Robins S, Brown G. Computer assisted screening: effect on the patient and his consultation. Br Med J (Clin Res Ed) 1985 Jun 8;290(6483):1709–1712. [PMC free article] [PubMed]
  • Pringle M, Robins S, Brown G. Timer: a new objective measure of consultation content and its application to computer assisted consultations. Br Med J (Clin Res Ed) 1986 Jul 5;293(6538):20–22. [PMC free article] [PubMed]
  • Pringle M, Robins S, Brown G. Topic analysis: an objective measure of the consultation and its application to computer assisted consultations. Br Med J (Clin Res Ed) 1985 Jun 15;290(6484):1789–1791. [PMC free article] [PubMed]
  • Weingarten MA, Bazel D, Shannon HS. Computerized protocol for preventive medicine: a controlled self-audit in family practice. Fam Pract. 1989 Jun;6(2):120–124. [PubMed]
  • Brownbridge G, Evans A, Wall T. Effect of computer use in the consultation on the delivery of care. Br Med J (Clin Res Ed) 1985 Sep 7;291(6496):639–642. [PMC free article] [PubMed]
  • Rosser WW, Hutchison BG, McDowell I, Newell C. Use of reminders to increase compliance with tetanus booster vaccination. CMAJ. 1992 Mar 15;146(6):911–917. [PMC free article] [PubMed]
  • McDowell I, Newell C, Rosser W. Comparison of three methods of recalling patients for influenza vaccination. CMAJ. 1986 Nov 1;135(9):991–997. [PMC free article] [PubMed]
  • McDonald CJ, Hui SL, Smith DM, Tierney WM, Cohen SJ, Weinberger M, McCabe GP. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med. 1984 Jan;100(1):130–138. [PubMed]
  • Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care. 1986 Aug;24(8):659–666. [PubMed]
  • Ornstein SM, Garr DR, Jenkins RG, Rust PF, Arnon A. Computer-generated physician and patient reminders. Tools to improve population adherence to selected preventive services. J Fam Pract. 1991 Jan;32(1):82–90. [PubMed]
  • Garr DR, Ornstein SM, Jenkins RG, Zemp LD. The effect of routine use of computer-generated preventive reminders in a clinical practice. Am J Prev Med. 1993 Jan-Feb;9(1):55–61. [PubMed]
  • McDowell I, Newell C, Rosser W. Computerized reminders to encourage cervical screening in family practice. J Fam Pract. 1989 Apr;28(4):420–424. [PubMed]
  • McDowell I, Newell C, Rosser W. A randomized trial of computerized reminders for blood pressure screening in primary care. Med Care. 1989 Mar;27(3):297–305. [PubMed]
  • McPhee SJ, Bird JA, Jenkins CN, Fordham D. Promoting cancer screening. A randomized, controlled trial of three interventions. Arch Intern Med. 1989 Aug;149(8):1866–1872. [PubMed]
  • Chambers CV, Balaban DJ, Carlson BL, Ungemack JA, Grasberger DM. Microcomputer-generated reminders. Improving the compliance of primary care physicians with mammography screening guidelines. J Fam Pract. 1989 Sep;29(3):273–280. [PubMed]
  • Hart JT, Thomas C, Gibbons B, Edwards C, Hart M, Jones J, Jones M, Walton P. Twenty five years of case finding and audit in a socially deprived community. BMJ. 1991 Jun 22;302(6791):1509–1513. [PMC free article] [PubMed]
  • Donald JB. On line prescribing by computer. Br Med J (Clin Res Ed) 1986 Apr 5;292(6525):937–939. [PMC free article] [PubMed]
  • Donald JB. Prescribing costs when computers are used to issue all prescriptions. BMJ. 1989 Jul 1;299(6690):28–30. [PMC free article] [PubMed]
  • Gehlbach SH, Wilkinson WE, Hammond WE, Clapp NE, Finn AL, Taylor WJ, Rodell MS. Improving drug prescribing in a primary care practice. Med Care. 1984 Mar;22(3):193–201. [PubMed]
  • Brownbridge G, Evans A, Fitter M, Platts M. An interactive computerized protocol for the management of hypertension: effects on the general practitioner's clinical behaviour. J R Coll Gen Pract. 1986 May;36(286):198–202. [PMC free article] [PubMed]
  • Gilliland A, Mills KA, Steele K. General practitioner records on computer--handle with care. Fam Pract. 1992 Dec;9(4):441–450. [PubMed]
  • McAlister NH, Covvey HD, Tong C, Lee A, Wigle ED. Randomised controlled trial of computer assisted management of hypertension in primary care. Br Med J (Clin Res Ed) 1986 Sep 13;293(6548):670–674. [PMC free article] [PubMed]
  • Grimshaw JM, Russell IT. Achieving health gain through clinical guidelines II: Ensuring guidelines change medical practice. Qual Health Care. 1994 Mar;3(1):45–52. [PMC free article] [PubMed]
  • Rethans JJ, Höppener P, Wolfs G, Diederiks J. Do personal computers make doctors less personal? Br Med J (Clin Res Ed) 1988 May 21;296(6634):1446–1448. [PMC free article] [PubMed]
  • Harriss C, Pringle M. Do general practice computer systems assist in medical audit? Fam Pract. 1994 Mar;11(1):51–56. [PubMed]
  • Bleich HL, Beckley RF, Horowitz GL, Jackson JD, Moody ES, Franklin C, Goodman SR, McKay MW, Pope RA, Walden T, et al. Clinical computing in a teaching hospital. N Engl J Med. 1985 Mar 21;312(12):756–764. [PubMed]
  • FUNCTION of the hospital outpatient department. Lancet. 1953 Feb 7;1(6754):275–275. [PubMed]
  • Pringle M. The new agenda for general practice computing. BMJ. 1990 Oct 13;301(6756):827–828. [PMC free article] [PubMed]

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