Project:
COmputerised Guidelines Evaluation in the NorTh of England (COGENT)
Sponsors: NHS Executive, under their National R&D Programme
Clinical guidelines are systematically developed statements to assist practitioner decisions about appropriate health care for specific clinical circumstances. There is increasing interest in the role of clinical guidelines as a means of reducing inappropriate variations in clinical practice and promoting high quality care. However, there is a lack of consensus on how best to disseminate and implement guidelines in routine clinical practice. A recent review suggested that guidelines were most effective if they were implemented through patient-specific prompts contemporaneous with patient consultation, since failure to comply with guidelines may be due to information overload in the consultation rather than an inherent lack of knowledge. Advances in general practice computer systems now allow the generation of interactive prompts, based upon relatively complex guidelines, that can be presented on the screen during the patient consultation.
Aims of the study
The aim of the COGENT study is to evaluate the implementation of such interactive computerised guidelines. The North of England evidence-based guidelines for the primary care management of asthma and angina, which have been developed in a rigorous manner will form the basis of this implementation. Asthma and angina are chronic illnesses, cared for predominantly in primary care settings, and with significant morbidity and mortality rates; both are priority areas within "The Health of the Nation"; substantial differences between practices and doctors in the process of care and in patient outcomes are currently observed. The impact of the guidelines will be evaluated in terms of both the process and outcome of care. The study will incorporate an economic evaluation of the costs of guideline implementation and the costs and benefits to doctors and patients.
