Methodology Identification of publications Publications were identified by an initial generic search using words from any database field (i.e. words from titles, keywords and abstracts) after which all keywords yielding relevant publications were listed. Some of the search terms used were:
• database management systems AND primary health care;
• health information AND primary health care;
• IT AND primary health care;
• information systems AND primary health care;
• software AND primary health care; and
• software AND ambulatory care information systems.
Searches were performed for publication dates ranging from 1992 to 2002, and data sources included MEDLINE, Latin American and Caribbean Health Science Literature Database (LILACS), Cochrane Library and Web of Science. Some additional relevant studies were identified using a demonstration version of EMBASE and from the web site www.hi-europe.info. Inclusion and exclusion criteria Duplicate references were excluded, as were references without abstracts, those not specifically related to health, and those that were not concerned with health IT. Publications with abstracts were classified according to the PAHO criteria (Table 1) (4).
From the PAHO classification, the three categories most closely related to primary health-care practices were selected, i.e. systems for facilities, decision-support systems and electronic patient registration. The decision-support systems were subdivided into two groups: clinical decision-support (CDS) systems and process and programmatic action evaluation and management (PPAEM) systems. The systems initially considered as belonging to the facility category were later reclassified as belonging either to electronic patient registries (EPR) or to PPAEM. A further selection of abstracts was performed, including those related to the development and/or evaluation of IT within the scope of primary health care, which emphasized their potential contribution to health-care evaluations. Papers included at this stage were assigned to the following categories: benefits, barriers to implementation and improvement requisites