Eccles Martin, McColl Elaine, Steen Nick, Rousseau Nikki, Grimshaw Jeremy, Parkin David, Purves Ian
Centre for Health Services Research, University of Newcastle, Newcastle upon Tyne NE2 4AA, UK.
BMJ. 2002 Oct 26;325(7370):941. doi: 10.1136/bmj.325.7370.941.
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.
A before and after pragmatic cluster randomised controlled trial utilising a two by two incomplete block design.
60 general practices in north east England.
General practitioners and practice nurses in the study practices and their patients aged 18 or over with angina or asthma.
Adherence to the guidelines, based on review of case notes and patient reported generic and condition specific outcome measures.
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.
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.
评估在初级医疗中使用计算机化支持系统辅助决策，以实施基于证据的成人哮喘和心绞痛管理临床指南的效果。
采用二乘二不完全区组设计的前后实用整群随机对照试验。
英格兰东北部的60家全科诊所。
参与研究的诊所中的全科医生和执业护士及其18岁及以上患有心绞痛或哮喘的患者。
基于病例记录审查以及患者报告的通用和特定疾病结局指标，评估对指南的依从性。
计算机化决策支持系统对会诊率、护理过程指标（包括开药）或任何一种疾病患者报告的结局均无显著影响。软件的使用水平较低。
在初级医疗中，未发现基于计算机化证据的指南对成人哮喘或心绞痛管理有效果。这可能是由于软件使用水平较低，尽管该系统已在技术上尽可能进行了优化。即使解决了开发一个完全支持慢性病管理系统的技术问题，将这些系统整合到忙碌的从业者管理患有复杂多种疾病患者的临床诊疗过程中仍面临挑战。
