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 w orld reports from 1984 to 1994. Setting-The computerised catalogues of Medline, BIDS, and GPlit were searched, as well as conference proceed ings, books, bibliographies, and references in books and journal artic les. Subjects-30 papers met the inclusion criteria and were included f or detailed review. Interventions-A validated scheme for assessing met hodological adequacy was used to score each paper. Main outcome measur es-Papers were rated on sample formation, baseline differences, unit o f allocation, outcome measures, and follow up. Differences in outcomes were also recorded. Results-Four of the six papers dealing with the c onsultation process showed that consultations took longer. Doctor init iated and ''medical'' content of consultations increased at the expens e of a reduction in patient initiated and ''social'' content. Each of the 21 studies which looked at clinician performance showed an improve ment 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 cont rol 5 mm Hg better after one year, with fewer doctor-patient consultat ions). Conclusions-Using a computer in the consultation may help impro ve clinician performance but may increase the length of the consultati on. More studies are needed to assess the effects on patient outcomes of using a computer in consultations.