How do primary care providers respond to computer-generated, evidence-based care suggestions for patients with chronic heart failure?
Primary care providers agreed with less than half of computer-generated, evidence-based care suggestions for CHF, primarily citing inapplicability or patient intolerance rather than lack of guideline awareness.
OBJECTIVES: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale. RESULTS: Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study. CONCLUSIONS: Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
Keeffe et al. (2005) studied this question.