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Seeks to identify physicians' perceptions of possibilities and obstacles prior to implementing a computerised drug prescribing support system. Details a descriptive, qualitative study, with semi‐structured individual interviews of 21 physicians in the Accident and Emergency Department of South Stockholm General Hospital. Identifies four descriptive categories for possibilities and obstacles. Concludes that gaining access to patient drug history enables physicians to carry out work in a professional way – a need the computerised prescription support system was not developed for and thus cannot fulfil. Alerts and producer‐independent drug information are valuable in reducing workload. However, technical prerequisites form the base for a successful implementation. Time must be given to adapt to new ways of working.

The purpose of this paper is to contribute to the debate on the response of doctors to health policy initiatives in general and clinical governance in particular.

A qualitative approach has been adopted where the empirical data collection and the analysis are influenced by a phenomenological case study approach. An instrumental case study is undertaken and a heterogeneous group of 33 persons with important responsibilities for clinical governance was interviewed using a semi‐structured format.

The results indicate that doctors are not enthusiastic about clinical governance and it is not receiving wholehearted support from doctors because they feel that clinical governance is a management‐led initiative imposed without adequate consultations. The real reasons for lack of enthusiasm, indifference and sometimes resistance of doctors to clinical governance are examined. This paper points out the tension between an organisation (wishing to bring clinical care within a management framework) and doctors (who are resisting managerial efforts to replace the old framework of bureau professionalism).

Further research is required to develop a better understanding of the influence of clinical governance on power and conflict in NHS organisations.

This paper has practical implications for policy makers as well as NHS managers. Policy makers may consider suitable amendments in clinical governance to minimise resistance and seek the support of clinicians. A better understanding of this issue would perhaps enable NHS management to develop better management practices that will make it possible to seek the support of doctors for clinical governance.

Limited attention has been paid to understanding the response of doctors to clinical governance. This empirical research makes a valuable contribution by focusing on this important aspect of clinical governance.

This paper aims to examine whether a computerised system for medication reviews can support physicians' decisions and improve the quality of drug treatment in the elderly.

This is a descriptive intervention study. The study included 275 patients living in community settings and nursing homes in Stockholm, Sweden. Patient data were analysed using computer software and scrutinised by a clinical pharmacologist. Pharmaco‐therapeutic advice was sent to the physician responsible for each patient. The main outcome measures were initiation and discontinuation of drugs, changes of doses and rates of identified drug‐related problems.

Expert opinions were given by the clinical pharmacologist, for 275 patients, mean age 85 years; 70 per cent female. An average of 3.3 remarks was given concerning unsuitable drugs, unclear indication, dosing when the kidney function was decreased, drug‐drug interactions and quality indicators. On average 1.5 drug‐related problems (DRP) per patient were attended to by the responsible physician at each unit. The most common action taken was withdrawal of a drug (n=208). On average the drug use decreased from 10.4 to 9.5 drugs per patient, and several quality indicators were met. The drug costs decreased, and resulted in a more cost‐effective drug therapy.

The paper develops and tests a method for intervention in the care of elderly patients. The method is based on a computerised expert support system for medication reviews at a distance and on education of the staff. A safer drug therapy with improved quality and cost‐effectiveness is thus provided.

The purpose of this paper is to explore the implications of registered nurses’ (RNs) use of a computerized decision support system (CDSS) in medication reviews.

The paper employs a quasi-experimental, one-group pre-test/post-test design with three- and six-month follow-ups subsequent to the introduction of a CDSS. In total, 11 RNs initiated and prepared a total of 54 medication reviews. The outcome measures were the number of drug-related problems (DRPs) as reported by the CDSS and the RNs, respectively, the RNs’ views on the CDSS, and changes in the quality of drug treatment.

The CDSS significantly indicated more DRPs than the RNs did, such as potential adverse drug reactions (ADRs). The RNs detected additional problems, outside the scope of the CDSS, such as lack of adherence. They considered the CDSS beneficial and wanted to continue using it. Only minor changes were found in the quality of drug treatments, with no significant changes in the drug-specific quality indicators (e.g. inappropriate drugs). However, the use of renally excreted drugs in reduced renal function decreased.

The RNs’ use of a CDSS in medication reviews is of value in detecting potential ADRs and interactions. Yet, in order to have an impact on outcomes in the quality of drug treatment, further measures are needed. These may involve development of inter-professional collaboration, such as established procedures for the implementation of medication reviews, including the use of CDSS.

This is, to the best of the authors’ knowledge, the first study to explore the implications of medication reviews, initiated and prepared by RNs who use a CDSS. The paper adds further insight into the RNs’ role in relation to quality of drug treatments.