Computerised evidence based guidelines in primary care

Editor—I am worried that the paper by Rousseau et al on computerised evidence based guidelines in primary care may inhibit the development of primary care in the 21st century. ¹

My practice been using interactive decision support as an important facet of modern general practice for several years and received a “Doctor of the Year” award a couple of years ago, but we would not have been able to demonstrate the high quality general practice without the locally created doctor and nurse chronic and acute disease decision support software that we use.

Most chronic illness including hypertension, diabetes, and heart failure and acute care of illnesses such as back pain, asthma, and mental illness are managed successfully within the confines of routine general practice. Rousseau et al should make it quite clear what software has been used to allow primary care to distinguish this project from decision support software which is working well in every day practice. The analogy of ploughing a field may be useful. If a formula one racing car had been used to pull the plough, the readers would not be surprised if it were not up to the job. This could then have been reported as “internal combustion engine is less effective than the horse.”

We must not tar all decision support with the same brush—we couldn't work successfully without locally written decision support in our practice.