HAS GENERAL-PRACTITIONER COMPUTING MADE A DIFFERENCE TO PATIENT-CARE - A SYSTEMATIC REVIEW OF PUBLISHED REPORTS

Objective-To review findings from studies of the influence of desktop computers on primary care consultations. Design-Systematic review of world reports from 1984 to 1994. Setting-The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceedings, books, bibliographies, and references in books and journal articles. Subjects-30 papers met the inclusion criteria and were included for detailed review. Interventions-A validated scheme for assessing methodological adequacy was used to score each paper. Main outcome measures-Papers were rated on sample formation, baseline differences, unit of allocation, outcome measures, and follow up. Differences in outcomes were also recorded. Results-Four of the six papers dealing with the consultation process showed that consultations took longer. Doctor initiated and ''medical'' content of consultations increased at the expense of a reduction in patient initiated and ''social'' content. Each of the 21 studies which looked at clinician performance showed an improvement when a computer was used (from 8% to 50%, with better results for single preventive measures). Only one of the three studies looking at patient outcomes showed an improvement (diastolic blood pressure control 5 mm Hg better after one year, with fewer doctor-patient consultations). Conclusions-Using a computer in the consultation may help improve clinician performance but may increase the length of the consultation. More studies are needed to assess the effects on patient outcomes of using a computer in consultations.