title: Feasibility and impact of a computer-guided consultation on  guideline-based management of COPD in general practice.
abstract: BACKGROUND
  Applying guidelines is a universal challenge that is often not met. Intelligent software systems that facilitate real-time management during a clinical interaction may offer a solution.
  
  
  OBJECTIVE
  To determine if the use of a computer-guided consultation that facilitates the National Institute for Health and Clinical Excellence-based chronic obstructive pulmonary disease (COPD) guidance and prompts clinical decision-making is feasible in primary care and to assess its impact on diagnosis and management in reviews of COPD patients.
  
  
  METHODS
  Practice nurses, one-third of whom had no specific respiratory training, undertook a computer-guided review in the usual consulting room setting using a laptop computer with the screen visible to them and to the patient. A total of 293 patients (mean (SD) age 69.7 (10.1) years, 163 (55.6%) male) with a diagnosis of COPD were randomly selected from GP databases in 16 practices and assessed.
  
  
  RESULTS
  Of 236 patients who had spirometry, 45 (19%) did not have airflow obstruction and the guided clinical history changed the primary diagnosis from COPD in a further 24 patients. In the 191 patients with confirmed COPD, the consultations prompted management changes including 169 recommendations for altered prescribing of inhalers (addition or discontinuation, inhaler dose or device). In addition, 47% of the 55 current smokers were referred for smoking cessation support, 12 (6%) for oxygen assessment, and 47 (24%) for pulmonary rehabilitation.
  
  
  CONCLUSIONS
  Computer-guided consultations are practicable in general practice. Primary care COPD databases were confirmed to contain a significant proportion of incorrectly assigned patients. They resulted in interventions and the rationalisation of prescribing in line with recommendations. Only in 22 (12%) of those fully assessed was no management change suggested. The introduction of a computer-guided consultation offers the prospect of comprehensive guideline quality management.
authors.affiliation: Department of Respiratory Medicine, University Hospital Aintree, Liverpool, UK.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Angus
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Thompson
authors.forename: Lisa
authors.initials: L
authors.lastname: Davies
authors.forename: Ann
authors.initials: A
authors.lastname: Trusdale
authors.forename: Chris
authors.initials: C
authors.lastname: Hodgson
authors.forename: Eddie
authors.initials: E
authors.lastname: McKnight
authors.forename: Andrew
authors.initials: A
authors.lastname: Davies
authors.forename: Mike G
authors.initials: MG
authors.lastname: Pearson
mesh_terms: D000368:Aged; D019992:Databases as Topic; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D058006:General Practice; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis* / Q000628:therapy*; D012017:Referral and Consultation; D016540:Smoking Cessation