Montgomery A A, Fahey T
Division of Primary Health Care, University of Bristol.
J Epidemiol Community Health. 1998 Aug;52(8):520-5. doi: 10.1136/jech.52.8.520.
To assess the effect of computers and computer-based clinical decision support systems on the management of hypertension.
Systematic review of randomised controlled trials.
Ambulatory hypertension clinics, community-based health centres, and general practices.
11,962 patients enrolled in seven trials retrieved from a systematic search (electronic databases, contact with authors, reference lists; no restriction on language).
Individual trials report on a diverse population of patients (newly diagnosed or established hypertensive patients), interventions (computers used for case finding, recall and registration, feedback on quality of blood pressure control and prescribing information), and outcomes (administration, physician performance and blood pressure control). Four of five trials reported an improvement in patient administration using a computer. Two of three trials reported an improvement in physician performance using a computer. Two of six trials. reported an improvement in blood pressure control in patients using a computer. However, positive findings in two trials should be regarded cautiously because of the potential effects of cluster randomisation.
It seems that computers have a favourable effect on the uptake and follow up of patients in hypertension management. The effect of computers on physician knowledge, recording of information, and blood pressure control in patients is less conclusive and further studies are required.
评估计算机及基于计算机的临床决策支持系统对高血压管理的影响。
对随机对照试验的系统评价。
门诊高血压诊所、社区卫生中心和全科医疗诊所。
通过系统检索（电子数据库、与作者联系、参考文献列表；无语言限制）从7项试验中纳入的11962例患者。
各试验报告的患者群体（新诊断或已确诊的高血压患者）、干预措施（用于病例发现、召回和登记、血压控制质量反馈及处方信息的计算机）和结局（管理、医生表现和血压控制）各不相同。五项试验中有四项报告使用计算机可改善患者管理。三项试验中有两项报告使用计算机可改善医生表现。六项试验中有两项报告使用计算机可改善患者的血压控制。然而，由于整群随机化的潜在影响，两项试验中的阳性结果应谨慎看待。
计算机似乎对高血压管理中患者的纳入和随访有积极影响。计算机对医生知识、信息记录和患者血压控制的影响尚不确定，需要进一步研究。
