The Effects of On-Screen, Point of Care Computer Reminders on Processes and Outcomes of Care

ArticleinCochrane database of systematic reviews (Online) 3(3):CD001096 · February 2009with33 Reads
DOI: 10.1002/14651858.CD001096.pub2 · Source: PubMed
It is known that doctors do not always provide the care that is recommended or according to the latest research. Many strategies have been tried in an attempt to reduce this gap between what is recommended and what is done. A potentially low cost way to do this could be to use computer systems that remind physicians about important information while they make decisions. For example, a doctor could be ordering antibiotics for a child with an ear infection. At that point, the computer the doctor is working on displays a pop up window with a reminder about the evidence for the best dose and length of time the antibiotics should be prescribed. This review found 28 studies that evaluated the effects of different on-screen computer reminders. The studies tested reminders to prescribe specific medications, to warn about drug interactions, to provide vaccinations, or to order tests. The review found small to moderate benefits. The reminders improved physician practices by a median of 4%. In eight of the studies, patients' health improved by a median of 3%. Although some studies showed larger benefits than these median effects, no specific reminders or features of how they worked were consistently associated with these larger benefits. More research is needed to identify what types of reminders work and when.
    • "With the implementation of programs focused on clinicians, it is possible that comparatively small investments could produce significant returns among larger populations. These programs should be informed by the large corpus of research on clinician training and behavioural change, including: educational meetings [74]; reminders [75]; audit and feedback [76]; outreach visits [77] ; distribution of educational materials [78]; local opinion leaders [79]; and the freely available Health Systems Evidence database which contains these types of reviews [80]. Although, of course, even with the best training, clinicians would face many system-level barriers to optimal family planning services and IUD provision – including lack of availability, poor quality and high costs – which means that interventions targeting clinicians must be complemented by other interventions to strengthen the health systems in which they work. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: It is widely agreed that the practices of clinicians should be based on the best available research evidence, but too often this evidence is not reliably disseminated to people who can make use of it. This "know-do" gap leads to ineffective resource use and suboptimal provision of services, which is especially problematic in low- and middle-income countries (LMICs) which face greater resource limitations. Family planning, including intrauterine device (IUD) use, represents an important area to evaluate clinicians' knowledge and practices in order to make improvements. Methods: A questionnaire was developed, tested and administered to 438 individuals in China (n = 115), Kazakhstan (n = 110), Laos (n = 105), and Mexico (n = 108). The participants responded to ten questions assessing knowledge and practices relating to contraception and IUDs, and a series of questions used to determine their individual characteristics and working context. Ordinal logistic regressions were conducted with knowledge and practices as dependent variables. Results: Overall, a 96 % response rate was achieved (n = 438/458). Only 2.8 % of respondents were able to correctly answer all five knowledge-testing questions, and only 0.9 % self-reported "often" undertaking all four recommended clinical practices and "never" performing the one practice that was contrary to recommendation. Statistically significant factors associated with knowledge scores included: 1) having a masters or doctorate degree; and 2) often reading scientific journals from high-income countries. Significant factors associated with recommended practices included: 1) training in critically appraising systematic reviews; 2) training in the care of patients with IUDs; 3) believing that research performed in their own country is above average or excellent in quality; 4) being based in a facility operated by an NGO; and 5) having the view that higher quality available research is important to improving their work. Conclusions: This analysis supports previous work emphasizing the need for improved knowledge and practices among clinicians concerning the use of IUDs for family planning. It also identifies areas in which targeted interventions may prove effective. Assessing opportunities for increasing education and training programs for clinicians in research and IUD provision could prove to be particularly effective.
    Full-text · Article · Dec 2016
    • "We calculated the sample size on the basis of the primary outcome. A previous systematic review assessing the effects of computer reminders delivered to clinicians at the point-of-care on healthcare processes and outcomes found a median improvement of 4.2 % in process adherence across all reported process outcomes [57]. Accordingly, assuming resolution rates of 5 % in the intervention group versus 3 % in the control group due to a possible group contamination, we calculated that a sample of 4230 reminders will be necessary to detect the difference between the two groups (power = 0.90; α = 0.05, two-sided; 1:1 allocation). "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. Methods/design: We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. Discussion: The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES).
    Article · Jul 2016
    • "For example, the recommended 5A's behavioural counselling framework [55] has been reduced to include only three elements of care: 'assess, advise, and refer'373839 thereby reducing time demands on the clinician during the con- sultation [38, 56]. Similarly, practice aids such as prompts, decision-aids, recording and automated referral protocols have been demonstrated to be both effective in enhancing the provision of preventive care and in reducing the time required of clinicians [48, 57, 58]. Recommended models of preventive care provision emphasise the importance of referral and/or follow up care373839. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Preventive care for chronic disease risk behaviours by mental health clinicians is sub-optimal. Little research has examined the association between clinician attitudes and such care delivery. This study aimed to explore: i) the attitudes of a multi-disciplinary group of community mental health clinicians regarding their perceived role, perception of client interest, and perceived self-efficacy in the provision of preventive care, ii) whether such attitudes differ by professional discipline, and iii) the association between these attitudes and clinician provision of such care. Method: A telephone survey was conducted with 151 Australian community mental health clinicians regarding their attitudes towards provision of assessment, advice and referral addressing smoking, nutrition, alcohol, and physical activity, and their reported provision of such care. Logistic regression was used to examine the association between attitudes and care delivery, and attitudinal differences by professional discipline. Results: Most clinicians reported that: their manager supported provision of preventive care; such care was part of their role; it would not jeopardise their practitioner-client relationships, clients found preventive care acceptable, and that they had the confidence, knowledge and skills to modify client health behaviours. Half reported that clients were not interested in changing their health behaviours, and one third indicated that the provision of preventive care negatively impacted on time available for delivery of acute care. The following attitudes were positively associated with the provision of preventive care: role congruence, client interest in change, and addressing health risk behaviours will not jeopardise the client-clinician relationship. Conclusions: Strategies are required to translate positive attitudes to improved client care and address attitudes which may hinder the provision of preventive care in community mental health.
    Full-text · Article · Mar 2016
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