Related Experiment Videos
[Blood pressure records in general practice--expectations and reality]
E Dalen1, T E Widerøe, I Hetlevik
1Seksjon for nyresykdommer Medisinsk avdeling Regionsykehuset i Trondheim 7006 Trondheim.
Insights
Implementing computer-based clinical decision support systems in primary care is challenging. Doctors require systems that are available, simple, and financially compensated for effective use in managing hypertension.
Area of Science:
- Health Informatics
- Primary Care Medicine
- Clinical Decision Support
Context:
- Antihypertensive medication efficacy relies on controlled studies.
- Translating clinical study quality to primary care requires comparable management.
- Hypertension management quality in practice is key for treatment effectiveness.
Purpose:
- To implement a computer-based clinical decision support system for hypertension management in Norwegian primary care.
- To survey doctors' expectations regarding the implementation strategy of this system.
- To evaluate the implementation outcomes and compare them with doctors' initial expectations.
Summary:
- A computer-based clinical decision support system was implemented in primary care, with low physician participation and adherence.
- Only 37% of invited doctors agreed to participate, and only six of 74 continued using the system after 12 months.
- Physicians surveyed had overestimated acceptance rates, and their questionnaire responses were unreliable.
Impact:
- Computer-based clinical decision support system implementation faces significant hurdles in busy primary care settings.
- System availability and simplicity are critical for adoption.
- Financial compensation may be necessary to incentivize physician use of such systems.
Background:
The effect of antihypertensive medication on cardiovascular diseases is based on results achieved in prospective and controlled clinical studies. Comparable results in clinical practice can be achieved only when the quality of management for subjects with high blood pressure is comparable with the quality achieved in clinical studies.
Material And Methods:
This study consists of two parts; an attempt to implement an computer-based clinical decision support system for management of hypertension in primary health care in two counties in Norway, and a questionnaire survey among doctors in primary care and specialists in internal medicine in hospitals in other counties. We asked what they expected would be the result of the specific implementation strategy for the computer-based program. The objectives were to evaluate the results of the implementation strategy and to compare these results with expectations expressed in the filled-in questionnaires by doctors without any obligations to the main study.
Results:
A total of 175 doctors were invited to implement the clinical decision support system. 85% responded; 44% of these, or 37% of the invited doctors, were willing to participate. After 12 months with recurrent visits by one of the authors, only six out of 74 doctors participating in the intervention study still used the program. The questionnaire were completed and returned by 203 doctors, who expected that 55% of the invited doctors would accept the invitation following the implementation strategy used. In general the validity of the information given by the questionnaire was poor and unreliable.
Interpretation:
We conclude that introduction of a computer-based clinical decision support system is difficult in a busy primary care setting. Availability and simplicity are crucial requirements, and doctors would need financial compensation if they were to use such a system.