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Effects of Computerized Guidelines for Managing Heart Disease in Primary Care: A Randomized, Controlled Trial
Journal article   Open access   Peer reviewed

Effects of Computerized Guidelines for Managing Heart Disease in Primary Care: A Randomized, Controlled Trial

William M Tierney, J Marc Overhage, Michael D Murray, Lisa E Harris, Xiao-Hua Zhou, George J Eckert, Faye E Smith, Nancy Nienaber, Clement J McDonald and Fredric D Wolinsky
Journal of general internal medicine : JGIM, Vol.18(12), pp.967-976
12/01/2003
DOI: 10.1111/j.1525-1497.2003.30635.x
PMCID: PMC1494965
PMID: 14687254
url
https://europepmc.org/articles/pmc1494965View
Published (Version of record) Open Access

Abstract

BACKGROUND: Electronic information systems have been proposed as one means to reduce medical errors of commission (doing the wrong thing) and omission (not providing indicated care). OBJECTIVE: To assess the effects of computer-based cardiac care suggestions. DESIGN: A randomized, controlled trial targeting primary care physicians and pharmacists. SUBJECTS: A total of 706 outpatients with heart failure and/or ischemic heart disease. INTERVENTIONS: Evidence-based cardiac care suggestions, approved by a panel of local cardiologists and general internists, were displayed to physicians and pharmacists as they cared for enrolled patients. MEASUREMENTS: Adherence with the care suggestions, generic and condition-specific quality of life, acute exacerbations of their cardiac disease, medication compliance, health care costs, satisfaction with care, and physicians' attitudes toward guidelines. RESULTS: Subjects were followed for 1 year during which they made 3,419 primary care visits and were eligible for 2,609 separate cardiac care suggestions. The intervention had no effect on physicians' adherence to the care suggestions (23% for intervention patients vs 22% for controls). There were no intervention-control differences in quality of life, medication compliance, health care utilization, costs, or satisfaction with care. Physicians viewed guidelines as providing helpful information but constraining their practice and not helpful in making decisions for individual patients. CONCLUSIONS: Care suggestions generated by a sophisticated electronic medical record system failed to improve adherence to accepted practice guidelines or outcomes for patients with heart disease. Future studies must weigh the benefits and costs of different (and perhaps more Draconian) methods of affecting clinician behavior.
 Heart Failure ambulatory information systems clinical practice guidelines coronary artery disease decision support systems drug utilization review Original

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