Table 1: Design and characteristics of the included studies
Citation,
year,
Country
1. Carroll
et al.34
2012.
USA.
2.
Hashimot
o et al.35
2011
Netherlan
ds
Populatio
n: No. of
centers/
providers
/ patients
(Interven
tion,
Control)
1/-/2098
(children
aged 3-11
years)
(I=1082,
C=1016)
Study
design,
setting
and
Duration
Focus of study
Intervention
Comparator
Outcome
measures
Key
findings
CCDSS
effect
Comments
Randomiz
ed
controlled
trial.
Communit
y based.
Duration:
21 months
To determine
whether a
parent survey
linked to
physician
prompts, using
a computer
decision
support system
affects
physicians’
diagnosis of
childhood
asthma.
Parents were
asked about
asthma
symptoms on a
pre-screener
form. If a parent
answered
yes, then the
physician
received a
prompt to
determine
whether an
asthma diagnosis
was appropriate
Standard
care: Parents
received no
screening
questions,
and
physicians
received no
prompt
Physicians’
diagnosis of
childhood
asthma based
on prompts
by the CDSS.
Significantly
more
children in
the
interventio
n group
were
diagnosed
with asthma
than in the
control
group
(8.6% vs.
5.8%,
P < 0.02).
Primary care
pediatric
clinic.
Not clear if
physician
training was
provided.
6/-/95
(adults
with
diagnosed
severe
asthma)
(I=51,C=3
8)
Pragmatic
randomise
d
prospectiv
e
multicentr
e study,
Academic
To investigate
whether an
internet-based
management
tool including
home
monitoring of
symptoms,
The intervention
involved
internet-based
management
comprising (1)
an electronic
diary; (2)
treatment
Conventional
asthma
treatment by
pulmonologis
ts
Cumulative
sparing of
oral
corticosteroid
s, asthma
control using
Asthma
control
Median
cumulative
sparing of
prednisone
was 205 in
the internet
strategy
group
(+) effect.
The
CHICA
(Child
Health
Improvem
ent
through
Computer
Automatio
n) system
was
effective
in
increasing
physician
diagnosis
of asthma
(+) effect
An
internetbased
managem
ent tool
in severe
asthma is
Outpatient
clinics of two
academic
tertiary care
hospitals and
four large
community
hospitals.
3. Van der
Meer et
al.36 2009,
Netherlan
ds
37 general
practices
and 1
academic
outpatient
departme
nt/69/20
0(adults
with
asthma)
(I=101,
C=99)
and
communit
y setting
Duration:
6 months
lung function
and fraction of
exhaled nitric
oxide (FENO)
facilitates
tapering of oral
corticosteroids
and leads to
reduction of
corticosteroid
consumption
without
worsening
asthma control
or asthmarelated quality
of life.
decision support
for the patients;
and
(3) Monitoring
support by a
study nurse.
Multicentre,
nonblinded,
Randomis
ed
controlled
trial,
Communit
y and
Academic
setting
Duration=
12 months
To assess the
long-term
clinical
effectiveness of
Internet-based
asthma selfmanagement
education
compared with
usual
physicianprovided care
alone.
Internet-based
self-management
program
included weekly
asthma control
monitoring and
treatment
advice, online
and group
education, and
remote Web
communications
with a
specialized
Questionnair
e(ACQ),
asthmarelated
quality of life
(AQLQ), FEV1
(Piko-1),
exacerbations
,
hospitalisatio
ns and
satisfaction
(Global
satisfaction
scale)
Usual
physicianprovided care
alone.
Process
outcomes:
(asthma
knowledge,
inhaler
technique
and selfreported
medication
adherence),
health care
provider
contacts for
asthma, use
compared
with 0 in
the
conventiona
l treatment
group.
(p=0.02)
Asthma
control,
Asthmarelated
quality of
life, FEV1,
exacerbatio
ns,
hospitalisati
ons and
satisfaction
with the
strategy
were not
different
between
groups.
Modest
improveme
nt in
asthma
knowledge,
inhaler
technique
and slightly
fewer
physician
visits in the
internet
group.
Treatment
superior
to
conventio
nal
treatment
in
reducing
total
corticoste
roid
consumpti
on
without
compromi
sing
asthma
control or
asthmarelated
quality of
life.
Patients were
trained
(+) effect.
Although
Internetbased selfmanagem
ent can
improve
some
asthma
outcomes,
the
improvem
ents were
small and
General
practice and
outpatient
department
based.
Education
and training
provided to
the
participants.
Non-blinded.
asthma nurse as
an adjunct to
usual care.
of internet
based asthma
monitoring
tool, and
medication
changes.
Clinical
outcomes:
primary:
Asthmarelated
quality of life,
(32-item
Asthma
Quality of Life
Questionnair
e)
Secondary:
Asthma
control
(ACQ),
symptomfree days,
prebronchodilat
or FEV1
(Piko-1),
daily inhaled
corticosteroid
dose, and
exacerbations
4. Van der
Meer et
al.37 2010
Netherlan
37/69/20
0( adults
with
partly
Prospectiv
e
randomise
d
To determine if
weekly selfmonitoring and
subsequent
Participants
monitored
asthma control
weekly with the
Usual care by
the general
practitioner
according to
Primary:
Asthma
control using
(ACQ),
changes
occurred
more often
in the
internet
group.
Modest
improveme
nt in
asthma
control and
lung
function
with the
Internet
interventio
n, but no
reduction in
exacerbatio
ns.
Improveme
nt in
asthmarelated
quality of
life was
slightly less
than
clinically
significant.
the
program
did not
reduce the
number of
exacerbati
ons.
Significant
improveme
nts in ACQ
score, 12
(+) effect
Weekly
selfmonitorin
Pragmatic
design.
Study
outcomes
ds
controlled
or
uncontroll
ed
asthma)
(I=101,
C=99)
controlled
trial.
Communit
y and
academic
Duration:
1 year
treatment
adjustment
leads to
improved
asthma control
in
patients with
partly and
uncontrolled
asthma at
baseline and
tailors asthma
medication to
individual
patients' needs
ACQ on the
Internet
and adjusted
treatment using
a selfmanagement
algorithm
supervised by an
asthma nurse
specialist
the Dutch GP
guidelines
based on
GINA
guidelines
spirometry
and ATAQ
(asthma
therapy
assessment
questionnaire
) control
Index.
Secondary:
Mean daily
dose
of inhaled
corticosteroid
(ICS), and the
proportion of
participants
using longacting β2agonists
(LABA) or
leukotriene
receptor
antagonists
(LTRA).
months in
the internet
group. Daily
inhaled
corticostero
id dose
significantly
increased in
the Internet
group
compared
to usual
care in the
first 3
months in
patients
with
uncontrolle
d asthma,
but not in
patients
with well or
partly
controlled
asthma.
After one
year there
were no
differences
in daily
inhaled
corticostero
id use or
long-acting
β2agonists
between the
Internet
g and
subseque
nt
treatment
adjustmen
t leads to
improved
asthma
control
in patients
with
partly and
uncontroll
ed asthma
at
baseline
and tailors
asthma
medicatio
n to
individual
patients'
needs.
were
reported by
the patients.
Patients were
trained to
measure
forced
expiratory
volume in 1
second
(FEV1) daily
with a handheld
electronic
spirometer
(PiKo1).
5. Taylor
et al.38
2008.
Australia.
3/50/1
(simulate
d patient)
(I=27,
C=23 ED
doctors)
Randomiz
ed control
trial,
Communit
y
Duration:
4 months
To evaluate the
effectiveness of
an integrated
and dynamic
electronic
decision
support
system for
management of
acute asthma in
the emergency
department
(ED).
Computerized
on-line point of
care system. It
integrated
asthma
management
pathways based
on current
guidelines into
clinical and
discharge
documentation.
Paper
documentatio
n consisted of
paper-based
clinical
records,
treatment
order sheets
and discharge
documentatio
n.
6. Fiks et
al.39 2009.
USA.
20//11919
(children
with
asthma
between
5-19 years
of age)
(I=6110,
C= 5809)
Prospectiv
e, clusterrandomiz
ed
controlled
trial,
Academic.
Duration:
5 months.
To assess the
impact of
influenza
vaccine
clinical alerts
on missed
opportunities
for vaccination
and on overall
influenza
immunization
rates for
children and
adolescents
with asthma.
Electronic health
record-based
clinical alerts for
influenza vaccine
appeared at all
office visits for
children
between 5 and
19 years of age
with asthma who
were due for
vaccine.
Routine care
Health
process
outcomes
Primary
outcome:
Quality of
asthma
documentatio
n–measured
using 10
documentatio
n variables
(clinical
parameters
and discharge
Documentati
on).
Secondary
outcome:
consultation
time
Health care
process
outcomesrates of
captured
opportunities
for influenza
vaccination
(visit-level
analysis) and
up-to-date
influenza
vaccination
among
patients with
group and
usual care.
Significantly
higher rates
of
documentat
ion in 7 out
of 10
variables,
including
provision of
written
short-term
asthma
managemen
t plans. No
significant
difference
in
consultatio
n times.
Standardize
d influenza
vaccination
rates
improved
3.4% more
at
interventio
n sites than
at control
sites
(+) effect
Significant
improvem
ents in
clinical
and
discharge
document
ation
ED based
Compares
clinicians
performance
Training: 2
minute
introduction
to the system,
including
basic
functions of
the program.
Simulated
patient
Modest
improvem
ents in
influenza
vaccinatio
n rates.
Primary care
sites of
children
hospital. Not
clear
information
on the
comparator.
Training was
provided.
7. Bell et
al.40 2010.
USA.
12//19450
(children)
(I=6, C=6)
Prospectiv
e cluster
randomise
d trial,
Academic
setting
Duration:
1 year
To determine if
clinical
decision
support (CDS)
embedded in
an electronic
health record
(EHR)
improves
clinician
adherence to
national
asthma
guidelines in
the primary
care setting in
the
management of
children with
persistent
asthma
identified by
International
Classification
of Diseases,
ninth edition
(ICD-9) codes.
Personalised
recommendation
in the form of
CDS alerts and
reminders based
on the
information
captured in the
paediatric
asthma control
test (PACT- to
capture asthma
symptom
frequency) and
diagnosis and
medication
history.
Passive
asthma
management
tools
available in
the electronic
health record
(EHR).
8.
-/-/300
Multicentr
To compare the
Internet group:
Two other
asthma
Health care
process
outcomes:
Proportion of
children with
at least 1
prescription
for controller
medication,
an up-to-date
asthma
care plan, and
documentatio
n of
performance
of officebased
spirometry.
Asthma
Increases in
the number
of
prescription
s for
controller
medications
, over time,
was 6%
greater
(P=.006)
and 3%
greater for
spirometry
(P =.04) in
the
interventio
n urban
practices.
Filing an
up-to date
asthma care
plan
improved
14%
(P=.03) and
spirometry
improved
6%
(P=.003) in
the
suburban
practices
with the
interventio
n.
Significantly
(+) effect
CDS in the
EHR, at
the point
of care,
improved
clinician
complianc
e with
National
Asthma
Education
Preventio
n Program
guidelines
.
Medical
practices
within the
Children’s
Hospital of
Philadelphia
(CHOP)
Paediatric
Research
Consortium.
Physicians
were trained.
Doesn’t
mention the
number of
providers
involved in
the study.
(+) effect
Primary care
Rasmusse
n et al.41
2005.
Denmark.
9.
Dexheime
r et al.42
2013.
USA.
(adults
with
asthma)
1/-/1100
(Children
2-18 years
of age
before
final
diagnosis
of asthma
were
e
randomise
d
controlled
trial with
three
parallel
groups.
Communit
y setting
Duration:
6 months
Prospectiv
e
randomiz
ed
controlled
trial.
704 after
final
diagnosis
outcome of
monitoring
and treatment
using a
physicianmanaged
online
interactive
asthma
monitoring tool
with
conventional
asthma
treatment in
primary care.
To implement
and evaluate a
fully
computerized
Asthma
detection
system
combined with
a paper-based
The Internetbased asthma
management
tool comprised
of (1) an
electronic diary,
(2) an action
plan for the
patients, and (3)
a decision
support system
for the physician.
Patients with
persistent
asthma received
advice on
treatment based
on their asthma
control.
groups:
specialist
group,
treatment
by an asthma
specialist in
an outpatient
clinic; and
a general
practitioner
(GP) group,
treatment by
GPs in
primary care.
For intervention
group patients
the system
generated the
asthma protocol
at triage, to
guide early
treatment
initiation.
Usual care,
i.e., no
reminders or
automatic
printout was
provided.
symptoms:
electronic
diary.
Asthma
quality of life:
AQLQ)
questionnaire
Lung
function:
Spirometry
Airway
responsivene
ss:
methacholine
challenge test
Primary
outcome
measure: the
time from ED
triage to
disposition
(discharge or
hospital
admission)
better
improveme
nt in the
Internet
group than
in the other
2 groups
regarding
asthma
symptoms,
quality of
life, lung
function,
airway
responsiven
ess.
Significant
improveme
nt in the use
of inhaled
corticosteoi
ds and its
compliance
in the
internet and
specialist
group.
No
difference
in time to
disposition.
ED length of
stay and
admission
rates and
were
(+) effect
When
physicians
and
patients
used an
interactiv
e
Internetbased
asthma
monitorin
g tool,
better
asthma
control
was
achieved.
based.
Doesn’t
mention the
number of
practitioners
and the
number of
centres. No
training
provided to
the
participants
or the GP’s
but the
laboratory
assistants
providing
spirometry
and
methacholine
test were
trained.
While the
automatic
asthma
detection
system
demonstr
ated good
levels of
identifyin
All the
patients
presenting to
the paediatric
ED were
screened and
randomized
to the
intervention
10. Smith
et al.43
2012. UK.
randomiz
ed),
Communit
y
Duration:
3 months
(I=358,
C=346)
asthma care
protocol in the
paediatric ED
to help
standardize
care and
reduce time to
disposition
decision.
29/-/911
(patients
5+ years
of age
with
severe
asthma)
(I=457,
C=454)
Cluster
randomise
d
controlled
trial,
Communit
y setting
Duration:
2.5 years
To evaluate
whether,
compared to
routine care,
use of asthma
risk registers
reduced
numbers of atrisk patients
experiencing
exacerbations,
improved
aspects of care
and altered
associated
Addition of
electronic alerts
visible to all staff
to the
computerised
records of
identified at-risk
patients to flag
their at-risk
status at each
contact. Staff
advised on how
to engage with,
and improve the
routine and
Control
practices
continued
usual care.
decision.
Secondary
outcomes:
guideline
adherence
measures
including
asthma
education
ordered,
protocol
found on
chart, any
asthma
scoring
performed.
similar
between the
two groups.
Primary
outcome:
number of
patients
experiencing
a moderatesevere
exacerbation
Secondary
outcome:
outpatient
attendances
for asthma,
primary care
contacts, ‘did
No
significant
effect on
Exacerbatio
ns. Relative
reductions
in
interventio
n
patients
experiencin
g
hospitalisati
ons,
accident
g
asthma
patients
among an
unselecte
d ED
populatio
n,
the
system
was not
effective
at
influencin
g outcome
measures
that relate
to the
timing of
asthma
care in the
paediatric
ED.
No effect
Using
asthma
risk
registers
in primary
care
did not
reduce
treated
exacerbati
ons, but
reduced
hospitalis
ations and
or control
group.
Doesn’t
clearly
mention the
number of
physicians,
respiratory
therapists
and nurses
involved in
the study.
Primary care
based.
Training
provided.
11. Kattan
et al.44
2006.
USA.
/435/937
(5-11year
old with
moderate
to severe
asthma)
(I=471,C=
468)
Randomiz
ed
controlled
trial.
Communit
y setting
Duration:
1 year
healthcare
costs.
emergency
management of,
at-risk asthma
patients
To assess the
effectiveness of
timely patient
specific
feedback
combined with
guidelinebased
recommendati
ons for changes
in therapy to
improve the
quality of
asthma care by
the providers
and on
resultant
asthma
morbidity.
Providers of
intervention
group children
were sent a
bimonthly
Computergenerated letters
based on
information
collected from
the child’s carer
through
telephone calls.
The letter
summarized the
child’s asthma
symptoms,
health service
use, and
medication use
with a
corresponding
recommendation
to step up or
step down
medications in
not attends’
(DNAs) at
consultations,
and asthma
medications.
Letters were
not sent to
the providers
of the
children in
the control
group
Health care
process
outcomes:
scheduled
visits and
changes in
medications.
Patient
outcomes:
maximum
number of
symptom
days, ED
visits and
hospitalizatio
ns for asthma,
and school
days missed
because of
asthma.
and
emergency,
out-of hours
contacts
and
increase in
prednisolon
e
prescription
for
exacerbatio
ns
Significant
increase in
scheduled
visit,
(17.1%
vs12.3%,
p=0.005).
And
significant
increase in
medication
step up vs
(46% Vs
35.6%,
p=0.03).
Significantly
fewer ED
visits in the
interventio
n group
compared
with
controls(0.8
7 vs 1.14
increased
prescripti
ons of
recommen
ded
preventati
ve
therapies
without
increasing
costs.
(+) effect
Patientspecific
feedback
to the
providers
increased
scheduled
asthma
visits,
increased
asthma
visits in
which
medicatio
ns were
stepped
up when
clinically
indicated,
and
reduced
ED visits.
Intervention
practitioners
were trained.
accordance with
the NAEPP
guidelines.
12.
Tierney et
al.45 2005.
USA.
4/266/70
6
(246
physicians
and 20
outpatient
pharmacis
ts)
Randomiz
ed
controlled
trial,
Academic
Duration:
3 years
To assess the
effect of
guidelinebased care
suggestions
delivered via
physicians’ and
pharmacists’
computers on
management of
patients with
asthma or
COPD.
Computerised
care suggestions
focusing on: (1)
pulmonary
function
tests, (2)
influenza and
pneumococcal
vaccinations, (3)
prescribing
inhaled steroid
preparations in
patients with
frequent
symptoms of
dyspnoea,
(4) prescribing
inhaled
anticholinergic
agents in
patients with
COPD, (5)
escalating doses
of inhaled bagonists for all
per year,
p=0.013)
Four groups:
physician
intervention
only,
pharmacist
intervention
only, both
pharmacist
and physician
interventions,
and no
intervention
(controls).
Primary:
Adherence to
guideline
based care
suggestions.
Quality of
life-McMaster
Chronic
Respiratory
Disease
Questionnair
e (CRQ)
for COPD
patients or
the McMaster
Asthma
Quality-ofLife
Questionnair
e (AQLQ )
Patient
satisfaction:
American
Board of
Internal
No
difference
in the
maximum
number of
symptom
days and
number of
school days
missed.
There were
no
differences
between
groups in
adherence
to the care
suggestions,
quality of
life,
satisfaction
with
physicians’
or
pharmacists
, medication
compliance,
emergency
department
visits, or
hospitalizati
ons.
Physicians
receiving
the
No effect
Care
suggestio
ns
directed
at
physicians
and
pharmacis
ts had no
effect on
the
delivery
or
outcomes
of care for
patients
with
reactive
airways
disease.
Hospital
based
academic
practices.
Providers
included
internal
medicine
physicians,
residents and
pharmacists.
Training was
provided to
the providers.
Questionnair
es were
administered
via telephone.
13.
Martens
et al.46
2006.
Netherlan
ds.
-/53/-
Clustered
RCT(rand
omised
clinical
trial)
Communit
y
Duration:
1 year
To evaluate the
implementatio
n of a decision
support system
with reactive
computer
reminders
(CRS) to
improve drug
prescribing
behaviours.
patients with
persistent
symptoms, (6)
prescribing
theophylline for
patients with
COPD and
continued
symptoms
despite
aggressive use of
inhaled
anticholinergic
agents, bagonists, and
steroids, and (7)
encouraging
smoking
cessation.
Prescribing
guidelines were
integrated into
the GP
information
system. 25 GPs
received
reminders on
antibiotics and
asthma/COPD
prescriptions, 28
GPs received
reminders on
cholesterol
prescriptions.
GPs received
reminders on
cholesterol
prescriptions
Medicine’s
patient
satisfaction
questionnaire
Medication
adherence:
Inui and
Morisky
surveys and
pharmacy
records
interventio
n had
significantly
higher total
health care
costs.
Physician
attitudes
toward
guidelines
were mixed.
Primary
outcome:
prescription
according to
the guidelines
as a
percentage of
total
prescription
of a certain
drug.
Secondary
outcome:
user
friendliness.
CRS with
reactive
reminders
improves
drug
prescribing
behaviour.
Preliminary
results also
indicates
reduction in
the number
of
prescription
according to
the advices
of the
computeris
ed
(+) effect
Not
significant
CRS
improved
drug
prescribin
g and was
perceived
stable and
user
friendly.
Preliminary
study.
General
practice
based. Both
groups
served as
control to one
another.
CRS
reminders
only
appeared
when the GPs
deviated from
the guideline
recommendat
ions.
14.
Martens
et al.47
2007.
Netherlan
ds.
Follow-up
of the
above
study
14/53/-
Clustered
RCT
(randomiz
ed
controlled
trial),
Communit
y setting
Duration:
1 year
To assess the
effect on drugprescribing
behaviour of
implementing
prescribing
guidelines by
means of a
reactive
computer
reminder
system (CRS).
Prescribing
guidelines were
integrated into
the GP
information
system. 25 GPs
received
reminders on
antibiotics and
asthma/COPD
prescriptions
28 GPs
received
reminders on
cholesterol
prescriptions
Prescription
according to
the guideline
recommendat
ion as a
percentage of
total
prescriptions
(of the drug
category
involved) for
the same
diagnosis on
the individual
GP level.
Absolute
number of
prescriptions
for a specific
diagnosis per
GP per 1000
enlisted
patients.
15.
Martens
et al.48
2008.
20/48/-
Clustered
RCT
(randomis
ed
To evaluate the
feasibility and
acceptability of
a computer
Prescribing
guidelines were
integrated into
the GP
28 GPs
received
(reactive)
reminders on
Number of
GPs
(competent
and willing)
guidelines
not to
present
certain
drugs.
No
favourable
effects were
found for
computeris
ed
reminders
with the
message to
prescribe
certain
drugs. On
the other
hand,
computeris
ed
reminders
with the
message not
to prescribe
certain
drugs
sometimes
positively
influence
the
prescribing
behaviour
of GPs.
9% of GPs
dropped out
after 1 year.
(+) effect
Not
significant
. No
difference
s between
groups
were
found for
indicators
and
volumes
related to
recommen
dations
advocatin
g certain
drugs.
Not specific
to
asthma/COP
D. Both
groups
served as
control to one
another. This
study turned
out to be
underpowere
d due to high
inter doctor
variation in
prescribing
behaviour.
Training was
provided.
(+)
learning
effect
from the
Not specific
to
asthma/COP
D. Both
Netherlan
ds.
Follow-up
of the
above
study.
controlled
trial),
Communit
y setting
Duration:
1 year
reminder
system (CRS)
to improve
prescribing
behavior in
general
practice and to
explore its
strengths and
weaknesses.
information
system. 25 GPs
received
(reactive)
reminders on
antibiotics and
asthma/COPD
prescriptions
cholesterol
prescriptions
with CRS still
functioning
after 1 year.
Number of
GPs having
technical
problems or
are unwilling.
Number of
reminders/G
P/month/10
00 enlisted
patients.
GP user
satisfaction
(satisfaction
questionnaire
).
GP
experience
(content and
extensiveness
of CRS).
Barriers and
facilitators to
implementati
on and use of
CRS
16.
Kuilboer
et al.49
2006.
32/40/15
6,772
(study
patients
Randomis
ed
controlled
trial
To assess the
impact of
Asthma Critic
on monitoring
Asthma criticnon-inquisitive
critiquing system
that presents a
Usual care
Average
number of
contacts,
FEV1 (force
A significant
learning
curve was
found (p =
0.03) for
the
reminders
on
antibiotics,
asthma and
COPD.
GPs were
satisfied
with the
userfriendliness
and the
content of
the
different
types of
reminders,
but less
satisfied
with certain
specific
technical
performanc
e issues of
the system
CRS.
Statistically
significant
increase in
contact
(+) effect.
Guideline
based
critiquing
User
satisfactio
n on the
stability,
speed,
instructiv
eness,
layout and
support.
groups
served as
control to one
another. GP’s
were trained.
Not
satisfied
with
technical
issues.
General
practice
based. Study
focused on
Netherlan
ds.
(children
and
adults)
either had
chronic
bronchitis,
emphyse
ma, other
chronic
pulmonar
y diseases,
asthma or
COPD)
(I=20,
C=20
General
practition
ers)
Communit
y and
academic
Duration:
10 months
and treatment
of patients with
asthma and
COPD by Dutch
general
practitioners in
daily practice.
patient specific
comment to the
physician based
on the current
clinical situation.
17. Poels
et al.50
2008.
Netherlan
ds
1 medical
centre,
several
private
practices/
78/774
paper case
descriptio
ns.(10
case
descriptio
ns per
GP).
Simulated
clusterrandomise
d trial,
Communit
y
Duration=
10 months
To assess the
impact of
expert support
system for the
interpretation
of spirometry
tests on
GPs’ diagnostic
achievements
and decisionmaking
processes
when
diagnosing
The GPs’
received
spirometry test
results, flow
volume curve,
graphical
interpretation
and textual
interpretative
notes on the
results from the
expert system.
expiratory
volume) and
peak flow
measurement
s per
asthma/COP
D patient per
practice, and
the average
number of
antihistamine
, cromogylate,
deptropine,
and oral
bronchodialat
or
prescriptions
per
asthma/COP
D patient per
practice.
GPs in the
control group
received the
spirometry
test results,
and the flow–
volume and
volume–time
curves.
Primary:
Difference
between the
percentage
agreement of
the cases’
diagnoses
between GPs
and expert
panel
judgement
before and
after
interpretatio
frequency
with the
patient,
peak flow
measureme
nt, FEV1
measureme
nts in 12-39
years age
group,
however
there was a
decrease in
use of
chromogyla
teprescripti
ons in the
age group of
12-39 years,
deptropine,
antihistami
nes, oral
bronchodial
ators.
There were
no
differences
between the
expert
support and
control
groups in
the
agreement
between
GPs and
expert
panel on
system
changed
the
manner in
which
physicians
monitored
their
patients
and, to a
lesser
extent,
their
treatment
behavior.
It also
changed
their datarecording
habits.
change in
physicians’
behavior.
Training was
provided to
the general
practitioners.
No effect
Simulated
study.
Training was
provided.
Computeri
sed
spirometr
y expert
support
system
had no
detectable
benefit on
general
practition
ers’
chronic
respiratory
disease.
n of
spirometry
Secondary:
Impact of the
expert system
intervention
on the GPs
decisionmaking
processes
through six
measures:
additional
diagnostic
test rates;
width of
differential
diagnosis;
certainty of
diagnosis;
estimated
severity of
disease;
referral rate;
and
medication or
nonmedication
changes.
18.Poels
et al.51
2009 The
Netherlan
ds
44//2098
(I=15
C=15
Chest
physician
=14)
Clusterrandomise
d trial.
Duration:
not
mentione
d.
To assess the
impact of two
modes of
spirometry
expert support
on Family
physicians’
GPs received
spirometry
interpretation
support by
either a chest
physician (who
had standard
Usual care
had standard
spirometry
software (i.e.
no additional
interpretatio
n support).
Primary: A
change of
diagnosis
after
spirometry
Secondary:
diagnosis of
COPD,
asthma and
absence of
respiratory
disease.
A higher
rate of
additional
diagnostic
tests was
observed in
the expert
support
group.
Differences
in
proportion
of changed
diagnoses
were not
statistically
diagnostic
achieveme
nts and
the
decisionmaking
process
when
diagnosin
g chronic
respirator
y disease.
No effect.
Neither
chest
physician
spirometr
y support
Training was
provided
19.
Frickton
et al.52
2011,
USA.
15/102/5
9,147.
(Patients
with
medically
complex
conditions
like
xerostomi
a, diabetes
mellitus,
COPD,
congestive
heart
failure).
Prospectiv
e,
randomiz
ed clinical
trial with
three
arms
(provider
activation,
patient
activation
and
control
group),
Communit
y setting
Duration=
2 years
(FPs’)
diagnoses and
planned
management in
patients with
apparent
respiratory
disease.
spirometry
software) or
expert
spirometry
support
software.
Compare the
impact of two
CDS
approaches
designed to
improve
quality and
safety of dental
care for those
with medically
complex
conditions.
Dentists and
hygienists
received alerts in
the EDRs when
patients
scheduled for
dental
appointments
had one of the
targeted medical
conditions.
In the patient
activation group
patients with
upcoming dental
appointments
who had one of
the targeted
medical
conditions
Patients in
the control
group
received
usual care.
Neither the
patients nor
the providers,
received
alerts about a
patient’s
medical
status or
personalized
care
guidelines.
referral rate,
additional
diagnostic
tests, and
disease
management
changes.
significant.
Primary:
Total use-the
overall
frequency
with which
providers
accessed the
guidelines
Web site via
the EDR for
any patient.
Targeted
use—the
proportion of
providers
who accessed
the care
guidelines in
general and
for targeted
Participants
in the
provider
and patient
activation
groups
increased
their use of
the system
during the
first
six months.
Provider
activation
was more
effective
than was
patient
activation.
However, it
There were
no
differences
in
secondary
outcomes.
nor expert
software
spirometr
y support
had a
significant
impact on
FPs’
diagnosis
of
respirator
y
conditions
or
managem
ent
decisions.
(+) effect
Use of
CDS—in
which
providers
were
alerted
through
EDRs or
patients
were
alerted
through
PHRs—
improved
dental
care
providers’
review of
clinical
Dental clinic
based.
Study was
not specific to
asthma/COP
D patients.
received a
notification
from HPDG
(health partners
dental group)
before the visit
and encouraged
the patient to
discuss it with
his or her dental
care provider at
the upcoming
appointment.
patients at
the point of
care.
Ongoing
use—the
proportion of
providers
who
continued to
access the
Web-based
guidelines
through-out
the study
period.
was not
sustainable,
and by the
end of
the study,
the rate of
use had
returned to
baseline
levels
despite
participants
’continued
receipt of
electronic
alerts
care
guidelines
for
patients
with
medically
complex
conditions
.