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Evaluation of computer based clinical decision support system and risk chart for management of hypertension in
A A Montgomery1, T Fahey, T J Peters
1Division of Primary Health Care, University of Bristol, Bristol BS8 2PR.
Insights
A computer-based decision support system did not improve cardiovascular risk or blood pressure in hypertensive patients. However, a cardiovascular risk chart alone significantly lowered systolic blood pressure and increased cardiovascular drug prescriptions.
Area of Science:
- Cardiology
- General Practice
- Health Informatics
Background:
- Hypertension management requires effective tools to reduce cardiovascular risk.
- Clinical decision support systems (CDSS) and risk charts aim to improve patient outcomes.
- Evaluating these tools in primary care is crucial for evidence-based practice.
Purpose of the Study:
- To assess the impact of a CDSS and a cardiovascular risk chart on absolute cardiovascular risk, blood pressure, and medication prescribing in hypertensive patients.
- To compare the effectiveness of CDSS plus risk chart, risk chart alone, and usual care.
Main Methods:
- Cluster randomised controlled trial involving 27 general practices.
- 614 hypertensive patients aged 60-79 years were randomized.
- Interventions included CDSS + risk chart, risk chart alone, or usual care.
Main Results:
- Neither the CDSS nor the risk chart alone significantly reduced cardiovascular risk below 10% compared to usual care.
- The risk chart alone group showed a significant reduction in systolic blood pressure (-4.6 mm Hg).
- The risk chart alone group had increased prescribing of cardiovascular drugs.
Conclusions:
- The computer-based decision support system showed no benefit in absolute risk reduction or blood pressure control.
- The cardiovascular risk chart alone demonstrated a potential benefit in reducing systolic blood pressure.
- Further development and evaluation of CDSS are needed; risk charts show promise in primary care settings.
Objectives:
To investigate the effect of a computer based clinical decision support system and a risk chart on absolute cardiovascular risk, blood pressure, and prescribing of cardiovascular drugs in hypertensive patients.
Design:
Cluster randomised controlled trial.
Setting:
27 general practices in Avon.
Participants:
614 patients aged between 60 and 79 years with high blood pressure.
Interventions:
Patients were randomised to computer based clinical decision support system plus cardiovascular risk chart; cardiovascular risk chart alone; or usual care.
Main Outcome Measures:
Percentage of patients in each group with a five year cardiovascular risk >/=10%, systolic blood pressure, diastolic blood pressure, prescribing of cardiovascular drugs.
Results:
Patients in the computer based clinical decision support system and chart only groups were no more likely to have cardiovascular risk reduced to below 10% than patients receiving usual care. Patients in the computer based clinical decision support group were more likely to have a cardiovascular risk >/=10% than chart only patients, odds ratio 2.3 (95% confidence interval 1.1 to 4.8). The chart only group had significantly lower systolic blood pressure compared with the usual care group (difference in means -4.6 mm Hg (95% confidence interval -8.4 to -0.8)). Reduction of diastolic blood pressure did not differ between the three groups. The chart only group were twice as likely to be prescribed two classes of cardiovascular drugs and over three times as likely to be prescribed three or more classes of drugs compared with the other groups.
Conclusions:
The computer based clinical decision support system did not confer any benefit in absolute risk reduction or blood pressure control and requires further development and evaluation before use in clinical care can be recommended. Use of chart guidelines are associated with a potentially important reduction in systolic blood pressure.