Evaluation of an automated test ordering and feedback system for general practitioners in daily practice.
OBJECTIVE
To evaluate the use of an automated test ordering and feedback system (named GRIF) in daily practice. The system produces recommendations to general practitioners (GPs) to improve the application of accepted practice guidelines for test ordering.


METHODS
A randomised controlled trial with balanced block design was carried out in general practices in two regions of the Netherlands from August 2000 to July 2001. We implemented the GRIF system on the workstations at the offices of the participating GPs. The GPs (n=11) were asked to use GRIF during patient consultation instead of filling in the paper request form. The system displayed critical comments about their non-adherence to the guidelines as apparent from the request forms.


RESULTS
The median time of producing the comments plus the response time of the GP was 13s. Of the 2780 presented recommendations, 4.3% were accepted. Advice of the GRIF system that presents a concrete test to request in a particular situation is adhered to most frequently. Finally, there seems to be a decrease of accepted comments over the trial period.


CONCLUSIONS
Computerised recommendations should contain, if possible, suggestions for alternative tests to improve the application of these recommendations. Furthermore, creative solutions must be developed to avoid that GPs get used to the recommendations of critiquing systems and to stimulate a better adherence to these recommendations.
Department of Medical Informatics, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands. r.bindels@mi.unimaas.nl
Rianne
R
Bindels
Arie
A
Hasman
Jan W J
JW
van Wersch
Jan
J
Talmon
Ron A G
RA
Winkens
D000328:Adult; D001331:Automation; D003658:Decision Making, Computer-Assisted; D003937:Diagnosis, Differential; D005246:Feedback; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010821:Physicians, Family; D017410:Practice Guidelines as Topic; D017010:Reminder Systems; D016037:Single-Blind Method