The efficacy of an automated feedback system for general practitioners

• Published in: Informatics in primary care 2003, Vol.11 (2), p.69-74
• Main Authors: Bindels, Rianne, Hasman, Arie, Kester, Arnold D, Talmon, Jan L, De Clercq, Paul A, Winkens, Ron A G
• Format: Article
• Language: English
• Subjects: Clinical competence; clinical decision support systems; Decision Support Systems, Clinical; Family Practice - organization & administration; Female; guideline adherence; Humans; Male; Middle Aged; practice guidelines; Practice Guidelines as Topic; Primary Health Care - methods; primary healthcare; Reminder Systems; test ordering
• ISSN: 1476-0320; 2058-4555; 2058-4563
• DOI: 10.14236/jhi.v11i2.554

An automated feedback system that produces comments about the non-adherence of general practitioners (GPs) to accepted practice guidelines for ordering diagnostic tests was developed. Before implementing the automated feedback system in daily practice, we assessed the potential effect of the system on the test ordering behaviour of GPs. We used a randomised controlled trial with balanced block design. Five times six participant groups of GPs in a computer laboratory setting. The GPs reviewed a random sample of 30 request forms they filled in earlier that year. If deemed necessary, they could make changes in the tests requested. Next, the system displayed critical comments about their non-adherence to the guidelines as apparent from the (updated) request forms. Twenty-four randomly selected GPs participated. The number of requested diagnostic tests (17% with 95% confidence interval [CI]: 12-22%) and the fraction of tests ordered that were not in accordance with the practice guidelines (39% with 95% CI: 28-51%) decreased due to the comments of the automated feedback system. The GPs accepted 362 (50%) of the 729 reminders. Although our experiment cannot predict the size of the actual effect of the automated feedback system in daily practice, the observed effect may be seen as the maximum achievable.