Review: Computerised reminders and feedback can improve provider medication management

QUESTION: What is the effectiveness of computer generated medication reminders or feedback directed at healthcare providers or patients?

Data sources
English language studies were identified by searching Medline (1966–2001), CINAHL (1982–2001), COMPENDEX (1987–2001), the Cochrane Controlled Trials Register (1996–2001), and Current Contents (1997–2001); hand searching the contents pages of conference proceedings from MEDINFO (1980–92) and SCAMC/AMIA Annual Fall Symposium (1984–91); and reviewing reference lists of retrieved articles.

Study selection
Randomised controlled trials (RCTs) were included if they assessed the use of computers to assist in identifying patients and generating reminders or feedback. Studies of systems that calculated drug doses were excluded.

Data extraction
Data were extracted on setting, participants, nature of reminders, and rates of compliance. Quality of individual studies was scored for randomisation method (3 points), attention to comparability of baseline data (2), objectivity of primary outcome (4), loss to follow up (4), clarity of inclusion criteria (1), unit of allocation (1), ease of implementation of reminder system (1), and statistical analysis (1) (total possible points = 17).

Main results
26 trials (29 comparisons) were included in the analysis. Mean quality score was 13.6 (range 9–17). Meta-analysis was not possible because of heterogeneity among the individual studies. The results are summarised in the table.

Conclusions
Despite considerable variability in study quality and findings, some evidence shows that computerised feedback and reminders to providers improve management of medication; reminders are more effective than feedback