A PROSPECTIVE CONTROLLED TRIAL OF COMPUTERIZED DECISION-SUPPORT FOR LIPID MANAGEMENT IN PRIMARY-CARE

Objectives. This study aimed to assess the uptake and effect in primar y care of a computerized decision support system (DSS) for the managem ent of hyperlipidaemia. Method. A prospective controlled trial was con ducted in 25 practices covering a population of 150 000 in the city of Birmingham. The Primed system, a specialist developed, rule based DSS for general practice, was introduced prospectively after a 3-month ba seline data collection. The main outcome measures were nine months' da ta on prescribing of lipid lowering agents; use of laboratory tests; a nd referrals to secondary care for the investigation of hyperlipidaemi a.Results. System use was lower than expected. A shift was observed to wards requests for appropriate follow-up of previously abnormal lipid results and a greater emphasis on full lipid profiles, in line with th e DSS guidelines. Referrals showed a 55% decrease on those expected (N S). The prescribing evaluation revealed a large variation between prac tices, but no significant alteration following system use. Views of us ers favoured decision support as a concept, but criticised technical p roblems with the system. Conclusions. Greater integration of DSS softw are and practice based data handling systems is needed. The mode of da ta capture, and hence both the content and form of knowledge represent ation, in DSS must take greater account of the primary care consultati on process if such systems are to be of use to practitioners.