Study designs of evaluations included in the review
Randomised controlled trials (RCTs) and controlled trials were eligible for inclusion. The included studies lasted 1 or 2 years.
Specific interventions included in the review
Studies in which PEM were stored in or delivered by computer (including interactive packages) were eligible for inclusion. The information could be general or tailored to the individual patient, and could be delivered with or without the involvement of a health professional. The information could be delivered before, during or after a consultation. Simple patient reminders were excluded. The included studies were all based in primary care settings, and in all of the included studies patient-specific computer-generated PEM was provided as part of a multi-component intervention. The studies compared the following interventions:
computer-generated coronary artery disease risk profile PEM given 2 weeks after the first consultation versus profile given at 3 months' follow-up;
computer-generated reminder of cancer screening tests for patients and doctor plus booklet-based PEM versus usual practice; and
patient-specific computer-generated PEM and chart reminders of the prevention of cancers of the breast, cervix, colon, rectum and oral cavity plus nurse liaison versus usual practice.
Participants included in the review
Studies of health professions who were responsible for patient care were eligible for inclusion. Studies of researchers who were not clinically responsible for the patients were excluded. The participants in included studies were general practitioners (GPs) or workers in primary care practices. In one study the participating physicians received a reduction in malpractice insurance.
Outcomes assessed in the review
Studies that reported objective measures of health care professional practice (primary outcome for the review) or patient outcomes were eligible for inclusion. Studies that did not report measures of effect of practice were excluded. The individual studies assessed the ratio of high-risk to low-risk patients seen at 3 months' follow-up and the change in proportion of eligible patients having cancer screening tests.
How were decisions on the relevance of primary studies made?
At least two reviewers scanned the abstracts, and full-text reports were obtained of all potentially relevant articles. At least two reviewers then selected the studies, with any disagreements resolved by discussion.