Patient-specific computer-based decision support in primary healthcare--a randomized trial

Area of Science:

• Health Informatics
• Clinical Decision Support Systems
• Primary Healthcare Research

Background:

• Evidence for computer-based decision support systems in primary care is limited, especially for broad health problem coverage.
• A trial in Finland introduced evidence-based, patient-specific reminders into an Electronic Patient Record (EPR) system to assess their impact on care.
• The study aimed to determine if these reminders would decrease over time, indicating improved patient care.

Purpose of the Study:

• To evaluate the effect of patient-specific, evidence-based reminders integrated into an Electronic Patient Record (EPR) system on healthcare professionals' (HCPs) practice in primary care.
• To test the hypothesis that the total number of triggered reminders would decrease in the intervention group compared to the control group over a 12-month period.

Main Methods:

• A randomized trial involving 13,588 participants from July 2009 to October 2010, comparing an intervention group receiving visible EPR reminders with a control group not shown reminders.
• Reminders covered 59 health conditions and were triggered during EPR use.
• Data analysis utilized Generalized Estimation Equations (GEE) to compare the incidence rate ratio of triggered reminders between groups over 12 months.

Main Results:

• Contrary to expectations, the total number of triggered reminders increased in both groups over 12 months, with no significant difference between them.
• However, a significant finding emerged when analyzing a six-month follow-up: the total number of reminders increased significantly less in the intervention group compared to the control group, after controlling for confounding factors.
• This suggests a potential positive effect of the decision support system in the short term or under specific conditions.

Conclusions:

• The introduction of a patient-specific decision support system with computerized, tailored reminders did not lead to a decrease in triggered reminders over 12 months of follow-up in primary care.
• While the primary hypothesis was not supported at 12 months, the six-month analysis indicates a potentially beneficial, albeit smaller, increase in reminders within the intervention group.
• Further research may be needed to understand the long-term impact and optimal implementation of such systems.