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Methods Inf Med 2006; 45(04): 447-454
DOI: 10.1055/s-0038-1634103
Original Article
Schattauer GmbH

Computed Critiquing Integrated into Daily Clinical Practice Affects Physicians’ Behavior

A Randomized Clinical Trial with AsthmaCritic
M. M. Kuilboer
1   Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
M. A. M. van Wijk
1   Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
M. Mosseveld
1   Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
E. van der Does
2   Department of Family Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
J. C. de Jongste
3   Departments of Pediatrics/Pediatric Respiratory Medicine and Pulmonary Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
S. E. Overbeek
3   Departments of Pediatrics/Pediatric Respiratory Medicine and Pulmonary Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
B. Ponsioen
2   Department of Family Practice, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
,
J. van der Lei
1   Department of Medical Informatics, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
› Author Affiliations
Further Information

Publication History

Received: 01 February 2005

accepted: 30 September 2005

Publication Date:
06 February 2018 (online)

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Summary

Objective: We developed AsthmaCritic, a non-inquisitive critiquing system integrated with the general practitioners’ electronic medical records. The system is based on the guidelines for asthma and chronic obstructive pulmonary disease (COPD) as issued by the Dutch College of General Practitioners. This paper assesses the effect of AsthmaCritic on monitoring and treatment of asthma and COPD by Dutch general practitioners in daily practice.

Methods: A randomized clinical trial in 32 practices (40 Dutch general practitioners) using electronic patient records. An intervention group was given the use of AsthmaCritic, a control group continued working in the usual manner. Both groups had the disposal of the asthma and COPD guidelines routinely distributed by the Dutch College of General Practitioners. We measured the average number of contacts, FEV1 (forced ex-piratory volume), and peak-flow measurements per asthma/COPD patient per practice; and, the average number of antihistamine, cromoglycate, deptropine, and oral bronchodilator prescriptions per asthma/COPD patient per practice.

Results: The number of contacts increased in the age group of 12-39 years. The number of FEV1, peak-flow measurements, and the ratio of coded measurements increased, whereas the number of cromoglycate prescriptions decreased in the age group of 12-39 years.

Conclusions: Our study shows that the guideline-based critiquing system AsthmaCritic changed the manner in which the physicians monitored their patients and, to a lesser extent, their treatment behavior. In addition, the physicians changed their data-recording habits.

Keywords

Clinical decision support systems - computerized medical record - medical informatics - practice guidelines - feedback - asthma - COPD
 

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