A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97

• HIT Description: Any computing system designed for use by a doctor in primary care More info...
  
• Purpose of Study: Assess the effect of computers on primary care visits.
  
• Years of study: 1980-1997
  
• Study Design: Systematic review of studies of any design.
  
• Outcomes: Effects of computers on the visit process, on general practitionerÕs task performance, patient outcomes, potential barriers to effective implementation and doctorÕs or patientÕs attitudes toward computers.
  

• Settings: General practitioners offices
• Intervention: Varied among studies
• Evaluation Method: Varied among studies
• Barriers: Five themes emerged. The authors concluded there Òcould proveÓ major barriers to successful implementation of computers: privacy, the doctor patient relationship, cost, time and training.
• Healthcare Utilization: Computer use in ordering tests led to a reduction of 6-75% in the number of tests and cost savings of 8-14%.
• Quality of Care and Patient Safety Outcome: Immunization rates improved by 8-24% in the nine studies of computerization and immunization rates. Performance of preventive tasks such as blood pressure screening and cervical smears improved by up to 47%. Disease management was improved by the use of computers with four studies evaluating standards of diabetes care reporting improvements of 5-69%. Prescribing improved with computer support including prescribing of generic drugs. Studies on patient outcomes were rare. Only 17 such studies were identified and the results on patient outcomes were mixed.
• Changes in efficiency and productivity: Six studies looked at the consultation length, which increased from 48 to 130 seconds five of the studies, although the authors state, Òthis increase declined after variable time periodsÓ. In one study the doctors worked an average of 30 days before their consultation lengths returned to baseline levels. Two studies reported that doctors spent 11-100% more time on computerized records than they had on conventional records because of increased administrative tasks and preventive issues prompted by computer use.