Systematic reviews included in this broad synthesis

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Systematic review

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Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review.

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Journal JAMA : the journal of the American Medical Association
Year 2005
Links Pubmed DOI RxForChange

This article is included in 9 Broad syntheses 98 Broad syntheses (9 references) 2 Structured summaries of systematic reviews 98 Structured summaries of systematic reviews (2 references)

This article includes 100 Primary studies 98 Primary studies (100 references)

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OBJECTIVES: To review controlled trials assessing the effects of computerized clinical decision support systems (CDSSs) and to identify study characteristics predicting benefit. DATA SOURCES: We updated our earlier reviews by searching the MEDLINE, EMBASE, Cochrane Library, Inspec, and ISI databases and consulting reference lists through September 2004. Authors of 64 primary studies confirmed data or provided additional information. STUDY SELECTION: We included randomized and nonrandomized controlled trials that evaluated the effect of a CDSS compared with care provided without a CDSS on practitioner performance or patient outcomes. DATA EXTRACTION: Teams of 2 reviewers independently abstracted data on methods, setting, CDSS and patient characteristics, and outcomes. DATA SYNTHESIS: One hundred studies met our inclusion criteria. The number and methodologic quality of studies improved over time. The CDSS improved practitioner performance in 62 (64%) of the 97 studies assessing this outcome, including 4 (40%) of 10 diagnostic systems, 16 (76%) of 21 reminder systems, 23 (62%) of 37 disease management systems, and 19 (66%) of 29 drug-dosing or prescribing systems. Fifty-two trials assessed 1 or more patient outcomes, of which 7 trials (13%) reported improvements. Improved practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system (success in 73% of trials vs 47%; P = .02) and studies in which the authors also developed the CDSS software compared with studies in which the authors were not the developers (74% success vs 28%; respectively, P = .001). CONCLUSIONS: Many CDSSs improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Systematic review

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Health related virtual communities and electronic support groups: Systematic review of the effects of online peer to peer interactions.

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Journal BMJ (Clinical research ed.)
Year 2004
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 35 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 35 Broad syntheses (2 references)

This article includes 36 Primary studies 35 Primary studies (36 references)

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OBJECTIVE: To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. Design and data sources: Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. Selection of studies: We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. Main outcome measures: Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. RESULTS: 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. CONCLUSIONS: No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Systematic review

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Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review.

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Authors Kaushal R , Shojania KG , Bates DW
Journal Archives of internal medicine
Year 2003
Links Pubmed DOI RxForChange

This article is included in 6 Broad syntheses 12 Broad syntheses (6 references) 2 Structured summaries of systematic reviews 12 Structured summaries of systematic reviews (2 references)

This article includes 12 Primary studies 12 Primary studies (12 references)

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BACKGROUND: Iatrogenic injuries related to medications are common, costly, and clinically significant. Computerized physician order entry (CPOE) and clinical decision support systems (CDSSs) may reduce medication error rates. METHODS: We identified trials that evaluated the effects of CPOE and CDSSs on medication safety by electronically searching MEDLINE and the Cochrane Library and by manually searching the bibliographies of retrieved articles. Studies were included for systematic review if the design was a randomized controlled trial, a nonrandomized controlled trial, or an observational study with controls and if the measured outcomes were clinical (eg, adverse drug events) or surrogate (eg, medication errors) markers. Two reviewers extracted all the data. Discussion resolved any disagreements. RESULTS: Five trials assessing CPOE and 7 assessing isolated CDSSs met the criteria. Of the CPOE studies, 2 demonstrated a marked decrease in the serious medication error rate, 1 an improvement in corollary orders, 1 an improvement in 5 prescribing behaviors, and 1 an improvement in nephrotoxic drug dose and frequency. Of the 7 studies evaluating isolated CDSSs, 3 demonstrated statistically significant improvements in antibiotic-associated medication errors or adverse drug events and 1 an improvement in theophylline-associated medication errors. The remaining 3 studies had nonsignificant results. CONCLUSIONS: Use of CPOE and isolated CDSSs can substantially reduce medication error rates, but most studies have not been powered to detect differences in adverse drug events and have evaluated a small number of "homegrown" systems. Research is needed to evaluate commercial systems, to compare the various applications, to identify key components of applications, and to identify factors related to successful implementation of these systems.

Systematic review

Unclassified

Systematic review of scope and quality of electronic patient record data in primary care.

Authors Thiru K , Hassey A , Sullivan F
Journal BMJ (Clinical research ed.)
Year 2003
Links Pubmed DOI PubMed Central

This article is included in 2 Broad syntheses 1 Broad syntheses (2 references)

This article includes 1 Primary study 1 Primary studies (1 reference)

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OBJECTIVE: To systematically review measures of data quality in electronic patient records (EPRs) in primary care. DESIGN: Systematic review of English language publications, 1980-2001. DATA SOURCES: Bibliographic searches of medical databases, specialist medical informatics databases, conference proceedings, and institutional contacts. STUDY SELECTION: Studies selected according to a predefined framework for categorising review papers. DATA EXTRACTION: Reference standards and measurements used to judge quality. RESULTS: Bibliographic searches identified 4589 publications. After primary exclusions 174 articles were classified, 52 of which met the inclusion criteria for review. Selected studies were primarily descriptive surveys. Variability in methods prevented meta-analysis of results. Forty eight publications were concerned with diagnostic data, 37 studies measured data quality, and 15 scoped EPR quality. Reliability of data was assessed with rate comparison. Measures of sensitivity were highly dependent on the element of EPR data being investigated, while the positive predictive value was consistently high, indicating good validity. Prescribing data were generally of better quality than diagnostic or lifestyle data. CONCLUSION: The lack of standardised methods for assessment of quality of data in electronic patient records makes it difficult to compare results between studies. Studies should present data quality measures with clear numerators, denominators, and confidence intervals. Ambiguous terms such as "accuracy" should be avoided unless precisely defined.

Systematic review

Unclassified

Accuracy of computer diagnosis of melanoma: a quantitative meta-analysis.

Journal Archives of dermatology
Year 2003
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 22 Structured summaries of systematic reviews (1 reference) 2 Broad syntheses 22 Broad syntheses (2 references)

This article includes 22 Primary studies 22 Primary studies (22 references)

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BACKGROUND: Recent developments in computer technology have raised expectations that fully automated diagnostic instruments will become available to diagnose cutaneous melanoma without the need of human expertise. OBJECTIVES: To critically review the contemporary literature on computer diagnosis of melanoma, evaluate the accuracy of such computer diagnosis, analyze the influence of study characteristics, and compare the accuracy of computer diagnosis of melanoma with human diagnosis. METHODS: Quantitative meta-analysis of published reports. DATA SOURCES: Eligible studies were identified by a MEDLINE search covering the period from January 1991 to March 2002, by manual searches of the reference lists of retrieved articles, and by direct communication with experts. RESULTS: Thirty studies with substantial differences in methodological quality were deemed eligible for meta-analysis. Five of these complied with the predetermined list of "good quality" requirements, but none met all methodological quality requirements. Ten of these studies compared the performance of computer diagnosis with human diagnosis. The diagnostic accuracy achieved with computer diagnosis was statistically not different from that of human diagnosis (log odds ratios, 3.36 vs 3.51; P =.80). The diagnostic performance of the computer diagnosis was better for studies that used dermoscopic images than for studies that used clinical images (log odds ratios, 4.2 vs 3.4; P =.08). Other study characteristics did not significantly influence the accuracy of the computer diagnosis. CONCLUSIONS: The computer diagnosis of melanoma is accurate under experimental conditions, but the practical value of automated diagnostic instruments under real-world conditions is currently unknown. We suggest minimum requirements for methodological quality in future experimental studies or, ideally, randomized controlled trials.

Systematic review

Unclassified

Impact of emerging technologies on medication errors and adverse drug events.

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Authors Oren E , Shaffer ER , Guglielmo BJ
Journal American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists
Year 2003
Links Pubmed DOI RxForChange

This article is included in 3 Broad syntheses 25 Broad syntheses (3 references) 1 Structured summary of systematic reviews 25 Structured summaries of systematic reviews (1 reference)

This article includes 25 Primary studies 25 Primary studies (25 references)

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Published evidence on the effects of computerized physician order entry (CPOE), automated dispensing machines (ADMs), bar coding, and computerized medication administration records (CMARs) on medication errors and adverse drug events (ADEs) were reviewed. Emerging technologies have been recommended as potential mechanisms for reducing medication errors. Critical evaluations of the impact of these new technologies on medication errors and other adverse outcomes are lacking. PubMed was searched to identify all peer-reviewed publications linking four technologies (CPOE, ADMs, bar coding, and CMARs) with reductions in medication errors and ADEs and secondary endpoints. All controlled studies that assessed the impact of the technologies were evaluated. The appropriateness of the use of these technologies was also examined. Few studies were identified that evaluated the technologies' impact on these endpoints. Of the evaluated technologies, CPOE was the most studied; however, investigations were limited to selected medical centers. The appropriateness of use of the technologies was evaluated even more infrequently. A literature review revealed a paucity of controlled, generalizable studies confirming the benefits of technologies intended to reduce medication errors and ADEs. Very little evidence on the appropriateness of the use of these technologies was found.

Systematic review

Unclassified

Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials.

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Authors Bennett JW , Glasziou PP
Journal The Medical journal of Australia
Year 2003
Links Pubmed DOI RxForChange

This article is included in 4 Broad syntheses 26 Broad syntheses (4 references)

This article includes 26 Primary studies 26 Primary studies (26 references)

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OBJECTIVE: To systematically review randomised controlled trials (RCTs) of computer-generated medication reminders or feedback directed to healthcare providers or patients. DATA SOURCES: Extensive computerised and manual literature searches identified 76 English-language reports of RCTs reported before 1 January 2002. Searches were conducted between June 1998 and April 2002. STUDY SELECTION: 26 papers making 29 comparisons (two papers reported on multiple interventions) of computer-supported medication management to a control group. DATA EXTRACTION: The quality of the RCTs was systematically assessed and scored independently by two reviewers. Rates of compliance with (potential) reminders for the control and intervention groups were extracted. DATA SYNTHESIS: Heterogeneity of studies prevented a meta-analysis. Where possible, rates were calculated using the intention-to-treat principle. The comparisons were grouped into five areas. Reminders to providers in outpatient settings: six of 12 comparisons demonstrated positive effects (relative rates [RRs: intervention rates/control rates], 1.0 to 42.0). Provider feedback in outpatient settings: five of seven comparisons showed improved clinician behaviour (RRs, 1.0 to 2.5). Combined reminders and feedback in outpatient settings: the single comparison found no improvement. Reminders to providers in inpatient settings: three of five comparisons showed improvements (RRs, 1.0 to 2.1). Patient-directed reminders: two of four comparisons showed improvements in patient compliance. CONCLUSION: Reminders are more effective than feedback in modifying physician behaviour related to medication management. Patient-directed reminders can improve medication adherence.

Systematic review

Unclassified

Information skills training: a systematic review of the literature.

Authors Brettle A
Journal Health information and libraries journal
Year 2003
Links Pubmed DOI

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This article is included in 1 Broad synthesis 0 Broad syntheses (1 reference)

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The objectives of this study were to undertake a systematic review to determine the effectiveness of information skills training, to identify effective methods of training and to determine whether information skills training affects patient care. A systematic review, using an iterative approach to searching, was employed. Studies selected for inclusion in the review were critically appraised using a tool used in previous reviews. A tabular approach was used to provide a summary of each paper allowing synthesis of results. One thousand, three hundred and fifty-seven potentially relevant papers were located. On the basis of titles and abstracts, 41 potentially relevant studies were identified for potential inclusion. Further reading and application of the inclusion criteria left 24 studies for critical appraisal and inclusion in the review. Study designs included randomised controlled trials, cohort designs and qualitative studies. The majority of studies took place in US medical schools. Wide variations were found in course content and training methods. Eight studies used objective methods to test skills, two compared training methods and two examined the effects on patient care. There was limited evidence to show that training improves skills, insufficient evidence to determine the most effective methods of training and limited evidence to show that training improves patient care. Further research is needed in a number of areas.

Systematic review

Unclassified

A systematic review and economic evaluation of computerised cognitive behaviour therapy for depression and anxiety.

Journal Health technology assessment (Winchester, England)
Year 2002
Links Pubmed

This article is included in 1 Structured summary of systematic reviews 11 Structured summaries of systematic reviews (1 reference) 3 Broad syntheses 11 Broad syntheses (3 references)

This article includes 11 Primary studies 11 Primary studies (11 references)

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Executive summary available for free by visiting the document URL listed with this record.

Systematic review

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Do Internet interventions for consumers cause more harm than good? A systematic review.

Journal Health expectations : an international journal of public participation in health care and health policy
Year 2002
Links Pubmed DOI PubMed Central

This article is included in 1 Structured summary of systematic reviews 10 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 10 Broad syntheses (1 reference)

This article includes 10 Primary studies 10 Primary studies (10 references)

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Objective To systematically review the effect of consumer use of online health information on decision-making, attitudes, knowledge, satisfaction and health outcomes and utilization. Search strategy Electronic databases searched included the Cochrane Controlled Trials Register, MEDLINE, PREMEDLINE (to 14 March 2001), CINAHL, Australian Medical Index, Health and Society, National Institutes of Health Clinical Trials Database and CenterWatch. Inclusion criteria All post-1995 comparative studies (including controlled studies, before and after studies, and interrupted time series analyses) of Internet users vs. non-Internet users and other communications mediums, and Internet characteristics such as e-mail vs. other communication mediums, were included. Outcomes included consumer decision-making, attitudes, knowledge, satisfaction and measurable changes in health status or health utilization. Data extraction and synthesis One reviewer screened all papers then two reviewers independently assessed studies against the selection criteria and any discrepancies were resolved by discussion with a third reviewer. No attempt was made to combine the data for further statistical analysis. Main results We identified 10 comparative studies. Studies evaluated the effectiveness of using the Internet to deliver a smoking cessation programme, cardiac and nutrition educational programmes, behavioural interventions for headache and weight loss, and pharmacy and augmentative services. All studies showed some positive effects on health outcomes, although the methodological quality of many studies was poor. Conclusions Despite widespread consumer Internet use to obtain health-care information, there is almost a complete lack of evidence of any effects this may have on health outcomes.