Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials

John W Bennett and Paul P Glasziou
Med J Aust 2003; 178 (5): 217-222.


Objective: To systematically review randomised controlled trials (RCTs) of computer-generated medication reminders or feedback directed to healthcare providers or patients.

Data sources: Extensive computerised and manual literature searches identified 76 English-language reports of RCTs reported before 1 January 2002. Searches were conducted between June 1998 and April 2002.

Study selection: 26 papers making 29 comparisons (two papers reported on multiple interventions) of computer-supported medication management to a control group.

Data extraction: The quality of the RCTs was systematically assessed and scored independently by two reviewers. Rates of compliance with (potential) reminders for the control and intervention groups were extracted.

Data synthesis: Heterogeneity of studies prevented a meta-analysis. Where possible, rates were calculated using the intention-to-treat principle. The comparisons were grouped into five areas. Reminders to providers in outpatient settings: six of 12 comparisons demonstrated positive effects (relative rates [RRs: intervention rates/control rates], 1.0 to 42.0). Provider feedback in outpatient settings: five of seven comparisons showed improved clinician behaviour (RRs, 1.0 to 2.5). Combined reminders and feedback in outpatient settings: the single comparison found no improvement. Reminders to providers in inpatient settings: three of five comparisons showed improvements (RRs, 1.0 to 2.1). Patient-directed reminders: two of four comparisons showed improvements in patient compliance.

Conclusion: Reminders are more effective than feedback in modifying physician behaviour related to medication management. Patient-directed reminders can improve medication adherence.

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  • John W Bennett1
  • Paul P Glasziou2

  • 1 University Health Service, University of Queensland, Brisbane, QLD.
  • 2 School of Population Health, University of Queensland Medical School, Herston, QLD.



We thank the anonymous referees for their most thoughtful and constructive comments.

Competing interests:

None identified.

  • 1. Hanchak NA, Patel MB, Berlin JA, Strom BL. Patient misunderstanding of dosing instructions. J Gen Intern Med 1996; 11: 325-328.
  • 2. Rich M, Gray D, Beckham V, et al. Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. Am J Med 1996; 101: 270-276.
  • 3. Leape LL. Error in medicine. JAMA 1994; 272: 1851-1857.
  • 4. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press, 1999.
  • 5. Steel K, Gertman PM, Crescenzi C, Anderson J. Iatrogenic illness on a general medical service at a university hospital. N Engl J Med 1981; 304: 638-642.
  • 6. Einarson TR. Drug-related hospital admissions. Ann Pharmacother 1993; 27: 832-840.
  • 7. Austin SM, Balas EA, Mitchell JA, Ewigman BG. Effect of physician reminders on preventive care: meta-analysis of randomized clinical trials. In: Ozbolt JG, editor. Proceedings for 18th Annual Symposium on Computer Applications in Medical Care; 1994 November 5–9; Washington, DC. Philadelphia: Hanley & Belfus, 1994: 121-124.
  • 8. Shea S, DuMouchel W, Bahsmonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc 1996; 3: 399-409.
  • 9. Shiffman RN, Liaw Y, Brandt CA, Corb GJ. Computer-based guideline implementation systems: a systematic review of functionality and effectiveness. J Am Med Inform Assoc 1999; 6: 104-114.
  • 10. Balas EA, Boren SA, Brown GD, et al. Effect of physician profiling on utilization. Meta-analysis of randomized clinical trials. J Gen Intern Med 1996; 11: 584-590.
  • 11. Bennett JW, Glasziou PP. A review of the usefulness of computerised systems in clinical medicine. In: Royal Australian College of General Practitioners 7th Computer Conference; 1993 June 3–5. Melbourne: RACGP, 1993; 127-130.
  • 12. Bennett JW, Glasziou PP. A review of the usefulness of advice and therapy systems in clinical medicine. In: Hovenga, EJS, Whymark GK, editors. Proceedings of the Inaugural Health Informatics Conference; Brisbane, Australia; 1993 August 2–3. Melbourne: HISA, 1993; 228-233.
  • 13. Walton RT, Harvey EL, Dovey S, Freemantle N. Computerised advice on drug dosage to improve prescribing practice. In: Bero L, Grilli R, Grimshaw J, Oxman A, editors. Cochrane Collaboration on Effective Professional Practice Module of The Cochrane Database of Systematic Reviews [updated March 2001]. Available in The Cochrane Library. The Cochrane Collaboration; Issue 2. Oxford: Update Software, 2001.
  • 14. Moher D, Jadad AR, Tugwell P. Assessing the quality of randomized controlled trials. Current issues and future directions. Int J Technol Assess Health Care 1996; 12: 195-208.
  • 15. Guyatt GH, Sackett DL, Cook DJ, for the Evidence-Based Medicine Working Group. Users' guides to the medical literature. II. How to use an article about therapy or prevention. A. Are the results of the study valid? JAMA 1993; 270: 2598-2601.
  • 16. Sackett DL, Richardson WS, Rosenberg W, Haynes RB. Evidence-based medicine: how to practice and teach EBM. 1st ed. New York: Churchill Livingstone, 1997.
  • 17. McDonald CJ. Use of computer to detect and respond to clinical events: its effect on clinician behavior. Ann Intern Med 1976; 84: 162-167.
  • 18. McDonald CJ, Wilson GA, McCabe GP. Physician response to computer reminders. JAMA 1980; 244: 1579-1581.
  • 19. McDonald CJ, Hui SL, Smith DM, et al. Reminders to physicians from an introspective computer medical record. A two-year randomized trial. Ann Intern Med 1984; 100: 130-138.
  • 20. Tierney WM, Hui SL, McDonald CJ. Delayed feedback of physician performance versus immediate reminders to perform preventive care. Effects on physician compliance. Med Care 1986; 24: 659-666.
  • 21. Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med 1997; 12: 672-678.
  • 22. Hetlevik I, Holmen J, Kruger O. Implementing clinical guidelines in the treatment of hypertension in general practice. Evaluation of patient outcome related to implementation of a computer-based clinical decision support system. Scand J Prim Health Care 1999; 17: 35-40.
  • 23. Demakis JG, Beauchamp C, Cull WL, et al. Improving residents' compliance with standards of ambulatory care: results from the VA Cooperative Study on Computerized Reminders. JAMA 2000; 284: 1411-1416.
  • 24. Montgomery AA, Fahey T, Peters TJ, et al. Evaluation of computer based clinical decision support system and risk chart of management of hypertension in primary care: randomised controlled trial. BMJ 2000; 320: 686-690.
  • 25. McCowan C, Neville RG, Ricketts IW, et al. Lessons from a randomized controlled trial designed to evaluate computer decision support software to improve the management of asthma. Med Inform Internet Med 2001; 26: 191-201.
  • 26. Christakis DA, Zimmerman FJ, Wright JA, et al. A randomized controlled trial of point-of-care evidence to improve the antibiotic prescribing practices for otitis media in children. Pediatrics 2001; 107: E15-E18.
  • 27. Frances CD, Alperin P, Adler JS, Grady D. Does a fixed physician reminder system improve the care of patients with coronary artery disease? A randomized controlled trial. West J Med 2001; 175: 165-166.
  • 28. Rollman BL, Hanusa BH, Gilbert T, et al. The electronic medical record. Arch Intern Med 2001; 161: 189-197.
  • 29. Gehlbach SH, Wilkinson WE, Hammond WE, et al. Improving drug prescribing in a primary care practice. Med Care 1984; 22: 193-201.
  • 30. Hershey CO, Porter DK, Breslau D, Cohen DI. Influence of simple computerized feedback on prescription charges in an ambulatory clinic. A randomized clinical trial. Med Care 1986; 24: 472-481.
  • 31. Steele MA, Bess DT, Franse VL, Graber SE. Cost effectiveness of two interventions for reducing outpatient prescribing costs. Drug Intell Clin Pharm 1989; 23: 497-500.
  • 32. Meyer TJ, Van Kooten D, Marsh S, Prochazka AV. Reduction of polypharmacy by feedback to clinicians. J Gen Intern Med 1991; 6: 133-135.
  • 33. McCartney P, Macdowall W, Thorogood M. A randomised controlled trial of feedback to general practitioners of their prophylactic aspirin prescribing. BMJ 1997; 315: 35-36.
  • 34. Simon GE, VonKorff M, Rutter C, Wagner E. Randomised trial of monitoring, feedback, and management of care by telephone to improve treatment of depression in primary care. BMJ 2000; 320: 550-554.
  • 35. Tierney WM, Miller ME, Overhage JM, McDonald CJ. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization. JAMA 1993; 269: 379-383.
  • 36. Overhage JM, Tierney WM, McDonald CJ. Computer reminders to implement preventive care guidelines for hospitalized patients. Arch Intern Med 1996; 156: 1551-1556.
  • 37. Smith DM, Cox MR, Brizendine EJ, et al. An intervention on discharge polypharmacy. J Am Geriatr Soc 1996; 44: 416-419.
  • 38. Overhage JM, Tierney WM, Zhou XH, McDonald CJ. A randomized trial of "corollary orders" to prevent errors of omission. J Am Med Inform Assoc 1997; 4: 364-375.
  • 39. Shojania KG, Yokoe D, Platt R, et al. Reducing vancomycin use utilizing a computer guideline: results of a randomized controlled trial. J Am Med Inform Assoc 1998; 5: 554-562.
  • 40. Baird TK, Broekemeier RL, Anderson MW. Effectiveness of a computer-supported refill reminder system. Am J Hosp Pharm 1984; 41: 2395-2397.
  • 41. Simkins CV, Wenzioff NJ. Evaluation of a computerized reminder system in the enhancement of patient medication refill compliance. Drug Intell Clin Pharm 1986; 20: 799-802.
  • 42. Raynor DK, Booth TG, Blenkinsopp A. Effects of computer generated reminder charts on patients' compliance with drug regimens. BMJ 1993; 306: 1158-1161.
  • 43. L'Abbé KA, Detsky AS, O'Rourke K. Meta-analysis in clinical research. Ann Intern Med 1987; 107: 224-233.
  • 44. Mugford M, Banfield P, O'Hanlon M. Effects of feedback of information on clinical practice: a review. BMJ 1991; 303: 398-402.
  • 45. Overhage JM, Middleton B, Miller RA, et al. Does national regulatory mandate of provider order entry portend greater benefit than risk for health care delivery? J Am Med Inform Assoc 2002; 9: 199-208.
  • 46. McDonald CJ. The barriers to electronic medical record systems and how to overcome them. J Am Med Inform Assoc 1997; 4: 213-221.
  • 47. Litzelman DK, Dittus RS, Miller ME, Tierney WM. Requiring physicians to respond to computerized reminders improves their compliance with preventive care protocols. J Gen Intern Med 1993; 8: 311-317.


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