El Asmar, Marie LineDharmayat, Kanika I.Vallejo-Vaz, Antonio J.Irwin, RyanMastellos, Nikolaos2022-08-082022-08-082021El Asmar ML, Dharmayat KI, Vallejo-Vaz AJ, Irwin R, Mastellos N. Effect of computerised, knowledge-based, clinical decision support systems on patient-reported and clinical outcomes of patients with chronic disease managed in primary care settings: a systematic review. BMJ Open. 2021 Dec 22;11(12):e054659http://hdl.handle.net/10668/3892Objectives Chronic diseases are the leading cause of disability globally. Most chronic disease management occurs in primary care with outcomes varying across primary care providers. Computerised clinical decision support systems (CDSS) have been shown to positively affect clinician behaviour by improving adherence to clinical guidelines. This study provides a summary of the available evidence on the effect of CDSS embedded in electronic health records on patient-reported and clinical outcomes of adult patients with chronic disease managed in primary care. Design and eligibility criteria Systematic review, including randomised controlled trials (RCTs), cluster RCTs, quasi-RCTs, interrupted time series and controlled before-and-after studies, assessing the effect of CDSS (vs usual care) on patient-reported or clinical outcomes of adult patients with selected common chronic diseases (asthma, chronic obstructive pulmonary disease, heart failure, myocardial ischaemia, hypertension, diabetes mellitus, hyperlipidaemia, arthritis and osteoporosis) managed in primary care. Data sources Medline, Embase, CENTRAL, Scopus, Health Management Information Consortium and trial register clinicaltrials.gov were searched from inception to 24 June 2020. Data extraction and synthesis Screening, data extraction and quality assessment were performed by two reviewers independently. The Cochrane risk of bias tool was used for quality appraisal. Results From 5430 articles, 8 studies met the inclusion criteria. Studies were heterogeneous in population characteristics, intervention components and outcome measurements and focused on diabetes, asthma, hyperlipidaemia and hypertension. Most outcomes were clinical with one study reporting on patient-reported outcomes. Quality of the evidence was impacted by methodological biases of studies. Conclusions There is inconclusive evidence in support of CDSS. A firm inference on the intervention effect was not possible due to methodological biases and study heterogeneity. Further research is needed to provide evidence on the intervention effect and the interplay between healthcare setting features, CDSS characteristics and implementation processes.enAtribución-NoComercial 4.0 InternacionalAtribución-NoComercial 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc/4.0/General medicineHealth informaticsPreventive medicinePrimary careDiabetes mellitusChronic diseaseMedicina internaInformática médicaEnfermedad crónicaMedicina preventivaAtención primaria de saludMedical Subject Headings::Persons::Persons::Age Groups::AdultMedical Subject Headings::Diseases::Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Chronic DiseaseMedical Subject Headings::Organisms::Eukaryota::Animals::Chordata::Vertebrates::Mammals::Primates::Haplorhini::Catarrhini::Hominidae::HumansMedical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Comprehensive Health Care::Primary Health CareMedical Subject Headings::Information Science::Information Science::Medical Informatics::Medical Informatics Applications::Information Systems::Decision Support Systems, ClinicalMedical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Glucose Metabolism Disorders::Diabetes MellitusMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Epidemiologic Methods::Data Collection::Records as Topic::Medical Records::Medical Records Systems, Computerized::Electronic Health RecordsMedical Subject Headings::Diseases::Nutritional and Metabolic Diseases::Metabolic Diseases::Lipid Metabolism Disorders::Dyslipidemias::HyperlipidemiasMedical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Disease ManagementMedical Subject Headings::Diseases::Respiratory Tract Diseases::Lung Diseases::Lung Diseases, Obstructive::Pulmonary Disease, Chronic ObstructiveMedical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::Myocardial IschemiaMedical Subject Headings::Diseases::Cardiovascular Diseases::Heart Diseases::Heart FailureMedical Subject Headings::Information Science::Information Science::Information Storage and RetrievalMedical Subject Headings::Diseases::Cardiovascular Diseases::Vascular Diseases::HypertensionMedical Subject Headings::Diseases::Musculoskeletal Diseases::Bone Diseases::Bone Diseases, Metabolic::OsteoporosisMedical Subject Headings::Health Care::Health Services Administration::Patient Care Management::Delivery of Health CareMedical Subject Headings::Diseases::Musculoskeletal Diseases::Joint Diseases::ArthritisMedical Subject Headings::Diseases::Respiratory Tract Diseases::Bronchial Diseases::AsthmaMedical Subject Headings::Information Science::Information Science::Information Services::Bibliography as Topic::BibliometricsMedical Subject Headings::Analytical, Diagnostic and Therapeutic Techniques and Equipment::Investigative Techniques::Evaluation Studies as Topic::Clinical Trials as Topic::Controlled Clinical Trials as Topic::Randomized Controlled Trials as Topicresearch article34937723open access10.1136/bmjopen-2021-0546592044-6055PMC8705223