Computer decision support systems in general practice

The majority of healthcare contacts in the United Kingdom occur in primary care. The development of structured knowledge-based systems is being encouraged to assist doctors in diagnosis (Shortliffe et al., Medical Informatics, Addison-Wesley, Workingham, 1990). These systems may improve the quality of medical care (Delaney et al., Br. Med. J. 319 (1999) 1281). Benefits can occur in disease prevention with an improvement in immunisation rates by up to 18% and other preventive tasks by up to 50% (Sullivan and Mitchell, Br. Med. J. 311 (1995) 848-852). Other benefits have been seen with disease management. More appropriate dosing has been seen in patients taking drugs with a narrow therapeutic range (Gonzalez et al., Computer-assisted optimisation of aminophylline therapy in the emergency department, Am. J. Emergency Med. 7 (1989) 395-401) and improvements have been shown in the management of chronic physical illness where there is a clear consensus regarding treatment protocols Ryan et al., Health Care Computing 1 (1991) 332; Carson et al., Clinical decision support, systems methodology, and telemedicine: their role in the management of chronic disease, IEEE Trans. Tnf. Technol. Biomed. 2 (1998) 80-88). However, the consultation time is lengthened by their use and there is no appreciable impact on patient satisfaction (Sullivan and Mitchell, Br. Med. J. 311 (1995) 848-852). Both practitioners' conduct and the disclosure of information by the patient are adversely affected (Greatbatch et al., Fam. Practi. 12 (1995) 32-36), and many patients are concerned about confidentiality (Ridsdale and Hudd, Scand. J. Prim. Health Care 15 (1997) 180-183). Further, potential difficulties exist because of the wide variety of undifferentiated problems that are present in general practice. This makes evaluating the impact of computers in consultations particularly important (Feinstein, Lancet ii (1972) 421-423). These systems could potentially improve the quality of decisions made in the primary care consultation. However, considerable work is needed to ensure that their introduction is not detrimental to the quality of the relationship between the doctor and patient in the consultation, and to make the systems adaptable to local priorities. The systems need to be acceptable to both professionals and patients. (C) 2001 Elsevier Science Ltd. All rights reserved.