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Computerized guidelines for reactive airway disease do not affect care delivery or outcomes

According to a recently published study, care suggestions shown to doctors and pharmacists on computer workstations had no effect on the care delivery or outcomes of patients with asthma or chronic obstructive pulmonary disease (COPD). William M. Tierney, M.D., of Indiana University School of Medicine, and colleagues, suggest that one reason could be that providers may accept a computer's advice about preventive care and costs, but may be less open to a computer's suggestions about managing chronic illnesses.

With support from the Agency for Healthcare Research and Quality (HS07763), researchers randomized 246 physicians (mostly residents), and 20 outpatient pharmacists to the computerized asthma and COPD care guidelines or control groups at 25 academic medical practices. When writing orders or filling prescriptions using computer workstations, half of the physicians and pharmacists received care suggestions concerning drugs and monitoring. Randomizations resulted in four study groups: physician intervention, pharmacist intervention, both interventions, and controls. Researchers assessed guideline adherence and clinical activity using patients' medical records during the 3-year study period.

The average number of computerized care suggestions per patient was just under three. There were no differences between the four study groups in adherence to the care suggestions. There was also no consistent effect on patients' quality of life, medication adherence, or satisfaction with their physicians or pharmacists. There were no group differences in emergency department visits or hospitalizations for any cause or for reactive airways disease in particular. Researchers indicate that more work may be needed to improve the timing and content of computerized care suggestions.

See "Can computer-generated evidence-based care suggestions enhance evidence-based management of asthma and chronic obstructive pulmonary disease? A randomized, controlled trial," by Dr. Tierney, J. Marc Overhage, M.D., Ph.D., Michael D. Murray, Pharm.D., M.P.H., and others, in the April 2005 HSR: Health Services Research 40(2), pp. 477-497.

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