international journal of medical informatics 77 ( 2 0 0 8 ) 199–207 journal homepage: www.intl.elsevierhealth.com/journals/ijmi Feasibility and acceptability of a computerised system with automated reminders for prescribing behaviour in primary care J.D. Martens a,*,1 , T. van der Weijden a,b,1 , R.A.G. Winkens a,b,1 , A.D.M. Kester c,1 , P.J.H. Geerts a , S.M.A.A. Evers d,1 , J.L. Severens d,e,1 a Integrated Care Unit (RVE TZ), University Hospital Maastricht, Maastricht, The Netherlands b Department of General Practice/Centre for Quality of Care Research (WOK), Maastricht University, Maastricht, The Netherlands c Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands d Department of Health Organisation, Policy, and Economics (BEOZ), Maastricht University, Maastricht, The Netherlands e Department of Clinical Epidemiology and Medical Technology Assessment Unit, University Hospital Maastricht, The Netherlands article info Article history: Received 13 October 2006 Received in revised form 6 March 2007 Accepted 21 May 2007 Keywords: Drug therapy Practice guidelines General practice Decision Support Systems Process Evaluation abstract Objective: To evaluate the feasibility and acceptability of a computer reminder system (CRS) to improve prescribing behaviour in general practice and to explore the strengths and weak- nesses of a reminder system. One group of GPs received reminders on cholesterol lowering drugs, the other group on antibiotics, asthma and COPD drugs. Methods: Process evaluation of the computer reminder system being used by 53 GPs in 20 practices, by means of an analysis of the research database of the CRS. In addition, a ques- tionnaire and semi-structured face-to-face interview were conducted with all GP practices, two project leaders, and one technical consultant. Results: The strategy was largely carried out as planned, although the development period for the CRS had to be extended. Nine percent of the GPs dropped out. We found a signifi- cant learning curve without extinguishing effect (p = 0.03) for the antibiotics reminders. The questionnaire showed that, in general, GPs were satisfied with the user-friendliness and the content of the different types of reminders, but less satisfied with certain specific tech- nical performance issues of the system. The GPs reported mixed feelings towards the CRS in the interviews. They were generally positive about the guidelines themselves, but nega- tive regarding to the organisational context and the method of implementing the CRS. GPs stated that they sometimes manipulated the system to bypass reminders. Interviews with the project leaders and technical consultant revealed barriers to cooperation and miscom- munication between the different parties, and technical problems with multiple updates of the GP information system and the operating system. Conclusions: This process evaluation demonstrated that the implementation of the CRS was mainly carried out as planned, but the subjective experience of working with the CRS was not only positive. Participating GPs had mixed feelings, and quite a number of barriers need to be addressed to facilitate large-scale implementation of the CRS. Costs cannot be neglected, so it is important to analyse the balance between costs and effects. © 2007 Elsevier Ireland Ltd. All rights reserved. ∗ Corresponding author at: Integrated Care Unit (RVE TZ), University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Tel.: +31 43 3877390; fax: +31 43 3874438. E-mail address: jd.martens@caphri.unimaas.nl (J.D. Martens). 1 All the authors are involved in the Care and Public Health Research Institute (CAPHRI) of Maastricht University. 1386-5056/$ – see front matter © 2007 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijmedinf.2007.05.013