Chronic obstructive pulmonary disease (COPD) is major heath problem affecting 8–10 percent of the adult population and constitutes an important cause of death in older adults in Sweden . It is thus well recognised that CODP is a source of significant disability in work life, family roles, socialisation and functions of daily living, thereby leading to decreased health-related quality of life (HRQOL) [2–7]. Previous studies have shown weak relationships between physiological variables related to CODP, such as airflow and pulmonary function, and HRQOL [2, 4, 5]. A somewhat better relationship has been seen between HRQOL and respiratory symptoms . Still, patients with the same degree of airflow limitation have variable HRQOL scores, mainly due to the variability of coping strategies . The goal of health services is to help patients achieve the best possible health in terms of physical and mental functioning, but also with regard to the best possible HRQOL . It is therefore not surprising that HRQOL questionnaires have been introduced and used increasingly to evaluate the effects of various treatments for CODP . A recent review identified 37 different questionnaires in 69 studies during the last 5 years . A growing number of randomised or well-controlled studies have been performed in recent years to evaluate the effect of various drugs on respiratory diseases with regard to changes in health related quality of life [10–14]. In many of these studies the generic quality of life instrument SF-36 has been used and displayed an acceptable performance .
However, HRQOL questionnaires are so far mainly used in specific research settings and not widely accepted in routine care for patients with COPD  Several barriers, on the attitudinal and knowledge level in general, have been suggested by Deyo et al., including lack of knowledge of the questionnaire instrument, methods, terminology and perceptions about subjective information . The prevailing opinion appears to still be that physiological data or physicians' observations are more accurate in measuring outcome. Also, the cost of gathering, scoring and presenting questionnaire data on an individual basis has been deemed too costly or impractical in many instances [17, 18]. However, the inclusion of the patients' perspective in outcome measurement may facilitate a more holistic approach to health care intervention since both the clinician and the patient may provide valuable information . In addition, self-report not only emphasises the importance of the patients' perspective but also communicates respect to the patients with regard to their views as consumers .
The crucial importance of multiple perspectives in outcome assessment was emphasised in a previous study where physicians' ratings of HRQOL were only mildly related to the patient ratings . It was concluded from the study that incorporating patient self-report into routine care will help physicians in establishing a satisfactory relationship with their patients and improving patient satisfaction with care . However, on the other hand, inclusion of HRQOL assessment as part of a routine visit might increase the patients' expectations beyond what the physician may consider necessary and feasible and thereby generate dissatisfaction when these expectations are not met .
In a previous study evaluating the feasibility of using the SF-36 questionnaire in a routine health care setting, the added value concerning the patients' self-perceived health status was clearly appreciated by the physicians. It was noted, however, that implementing such a system would demand a non-existent system that could immediately collect and analyse data before the patient saw the physician . However, in earlier research we and others have worked on the development of computer programmes for various assessments to be used on a touch-sensitive screen and found this concept to be very user-friendly and reliable [21, 22]. In the present study we have tested such a computerised assessment system in routine care using the SF-36 questionnaire. We hypothesised that the introduction of routine assessment of SF-36 would facilitate a learning process leading to a widening of the physicians' view upon what is important for the patients.
The present study was undertaken in order to test the feasibility of a computerised system for collecting and analysing data from the SF-36 questionnaire in a routine outpatient setting. The more specific purpose of the study was to examine the thoughts and attitudes among physicians concerning the value of an HRQOL measurement in addition to the traditional clinical and laboratory data used.