Computer decision support systems for asthma: a systematic review

• Published in: NPJ primary care respiratory medicine 2014-05, Vol.24 (1), p.14005-14005, Article 14005
• Main Authors: Matui, Patricia, Wyatt, Jeremy C, Pinnock, Hilary, Sheikh, Aziz, McLean, Susannah
• Format: Article
• Language: English
• Subjects: 692/699/249/2510/31; 692/700; Asthma - therapy; Clinical Trials as Topic; Decision Support Systems, Clinical; Humans; Internal Medicine; Medicine; Medicine & Public Health; Outcome and Process Assessment, Health Care; Pneumology/Respiratory System; Primary Care Medicine; Quality of Life; Thoracic Surgery; Treatment Outcome
• ISSN: 2055-1010; 2055-1010
• DOI: 10.1038/npjpcrm.2014.5

Background: Increasing use of electronic health records offers the potential to incorporate computer decision support systems (CDSSs) to prompt evidence-based actions within routine consultations. Aim: To synthesise the evidence for the use of CDSSs by professionals managing people with asthma. Materials and methods: We systematically searched Medline, Embase, Health Technology Assessment, Cochrane and Inspec databases (1990 to April 2012, no language restrictions) for trials, and four online repositories for unpublished studies. We also wrote to authors. Eligible studies were randomised controlled trials of CDSSs supporting professional management of asthma. Studies were appraised (Cochrane Risk of Bias Tool) and findings synthesised narratively. Results: A total of 5787 articles were screened, and eight trials were found eligible, with six at high risk of bias. Overall, CDSSs for professionals were ineffective. Usage of the systems was generally low: in the only trial at low risk of bias the CDSS was not used at all. When a CDSS was used, compliance with the advice offered was also low. However, if actually used, CDSSs could result in closer guideline adherence (improve investigating, prescribing and issuing of action plans) and could improve some clinical outcomes. The study at moderate risk of bias showed increased prescribing of inhaled steroids. Conclusions: The current generation of CDSSs is unlikely to result in improvements in outcomes for patients with asthma because they are rarely used and the advice is not followed. Future decision support systems need to align better with professional workflows so that pertinent and timely advice is easily accessible within the consultation. Asthma management: Helping health professionals make decisions Currently available computer decision support systems (CDSSs) contribute little to improving clinical outcomes for people with asthma. CDSSs are interactive systems that are designed to assist physicians and other health professionals in making clinical decisions. As part of a systematic review, Susannah McLean and colleagues at the University of Edinburgh searched major bibliographic databases (Medline, Embase, Health Technology Assessment, Cochrane and Inspec) and online repositories for published reports, ongoing studies and unpublished trials on the use of CDSSs in the professional management of asthma. They found that CDSSs were generally ineffective for two reasons: the systems were rarely used and their