• Tom Blakeman, Carolyn Chew-Graham, David Reeves, Anne Rogers, and Peter Bower.
• School of Community Based Medicine, Health Sciences, Primary Care Research Group, The University of Manchester, Manchester. tom.blakeman@manchester.ac.uk
• Br J Gen Pract. 2011 Oct 1; 61 (591): e666e673e666-73.

BackgroundTwo key elements to improve the quality of care for people with long-term conditions in primary care are improved clinical information systems to support delivery of evidence-based care, and enhanced self-management support. Although both elements are viewed as necessary, their interaction is not well understood.AimTo explore the use of computer-based 'disease management' templates and their relevance to self-management dialogue within clinical encounters.Design And SettingQualitative study of general practices located in three primary care trusts in the north of England.MethodA qualitative mixed methods study was conducted that included comparative analysis of (1) observations of general practice consultations (n = 86); and (2) interviews with health professionals in general practice (n = 17).ResultsThe analysis suggested that use of the computer templates reinforced a checklist approach to consultations, which included professionals working through several self-management topics framed as discrete behaviours. As a consequence, conversation tended to become focused on the maintenance of the professional-patient relationship at the expense of expansion in self-management dialogue. The computer templates also shaped how patient-initiated self-management dialogue was managed when it arose, with a shift towards discussion around medical agendas.ConclusionIn order to enhance the management of long-term conditions in primary care, the design and implementation of clinical information systems to improve evidence-based care need to take into account their potential impact on supporting self-management.

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