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Computer decision support systems for asthma: a systematic review.

Matui P, Wyatt JC, Pinnock H, Sheikh A, McLean S - NPJ Prim Care Respir Med (2014)

Bottom Line: Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations.However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes.Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation.

View Article: PubMed Central - PubMed

Affiliation: Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.

ABSTRACT

Background: Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations.

Aim: To synthesise the evidence for the use of CDSSs by professionals managing people with asthma.

Materials and methods: We systematically searched Medline, Embase, Health Technology Assessment, Cochrane and Inspec databases (1990 to April 2012, no language restrictions) for trials, and four online repositories for unpublished studies. We also wrote to authors. Eligible studies were randomised controlled trials of CDSSs supporting professional management of asthma. Studies were appraised (Cochrane Risk of Bias Tool) and findings synthesised narratively.

Results: A total of 5787 articles were screened, and eight trials were found eligible, with six at high risk of bias. Overall, CDSSs for professionals were ineffective. Usage of the systems was generally low: in the only trial at low risk of bias the CDSS was not used at all. When a CDSS was used, compliance with the advice offered was also low. However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes. The study at moderate risk of bias showed increased prescribing of inhaled steroids.

Conclusions: The current generation of CDSSs is unlikely to result in improvements in outcomes for patients with asthma because they are rarely used and the advice is not followed. Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation.

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Related in: MedlinePlus

Theoretical model showing how a computer decision support system can improve asthma outcomes.
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fig1: Theoretical model showing how a computer decision support system can improve asthma outcomes.

Mentions: We anticipated considerable heterogeneity in the populations studied, and in the interventions and the outcomes reported in the trials precluding meta-analysis of data. Instead, we planned to undertake a narrative synthesis based on our theoretical model of how such computer systems are expected to exert their effects (see Figure 1). The expectation is that, in a linked causal chain, CDSSs will impact process outcomes, which, in turn, will impact clinical outcomes. The theory underpinning their effectiveness is that relevant reminders and recommendations during a consultation will influence clinicians’ behaviour and thereby improve guideline adherence as measured by process outcomes (e.g. more rational ordering of investigations, prescribing of treatment and use of asthma action plans). Implementation of evidence-based practices will consequently be measureable in clinical outcomes for asthma patients, such as fewer exacerbations, emergency department attendances and hospitalisations.


Computer decision support systems for asthma: a systematic review.

Matui P, Wyatt JC, Pinnock H, Sheikh A, McLean S - NPJ Prim Care Respir Med (2014)

Theoretical model showing how a computer decision support system can improve asthma outcomes.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4373260&req=5

fig1: Theoretical model showing how a computer decision support system can improve asthma outcomes.
Mentions: We anticipated considerable heterogeneity in the populations studied, and in the interventions and the outcomes reported in the trials precluding meta-analysis of data. Instead, we planned to undertake a narrative synthesis based on our theoretical model of how such computer systems are expected to exert their effects (see Figure 1). The expectation is that, in a linked causal chain, CDSSs will impact process outcomes, which, in turn, will impact clinical outcomes. The theory underpinning their effectiveness is that relevant reminders and recommendations during a consultation will influence clinicians’ behaviour and thereby improve guideline adherence as measured by process outcomes (e.g. more rational ordering of investigations, prescribing of treatment and use of asthma action plans). Implementation of evidence-based practices will consequently be measureable in clinical outcomes for asthma patients, such as fewer exacerbations, emergency department attendances and hospitalisations.

Bottom Line: Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations.However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes.Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation.

View Article: PubMed Central - PubMed

Affiliation: Allergy and Respiratory Research and eHealth Research Groups, Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK.

ABSTRACT

Background: Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations.

Aim: To synthesise the evidence for the use of CDSSs by professionals managing people with asthma.

Materials and methods: We systematically searched Medline, Embase, Health Technology Assessment, Cochrane and Inspec databases (1990 to April 2012, no language restrictions) for trials, and four online repositories for unpublished studies. We also wrote to authors. Eligible studies were randomised controlled trials of CDSSs supporting professional management of asthma. Studies were appraised (Cochrane Risk of Bias Tool) and findings synthesised narratively.

Results: A total of 5787 articles were screened, and eight trials were found eligible, with six at high risk of bias. Overall, CDSSs for professionals were ineffective. Usage of the systems was generally low: in the only trial at low risk of bias the CDSS was not used at all. When a CDSS was used, compliance with the advice offered was also low. However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes. The study at moderate risk of bias showed increased prescribing of inhaled steroids.

Conclusions: The current generation of CDSSs is unlikely to result in improvements in outcomes for patients with asthma because they are rarely used and the advice is not followed. Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation.

Show MeSH
Related in: MedlinePlus