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Does Clinical Decision Support Increase Appropriate Medication Prescribing for Cardiovascular Risk Reduction?
David Boston1, Annie E Larson2, Christina R Sheppler2
1From the OCHIN Inc., PO Box 5426, Portland, OR (DB, AEL, JH, RG); Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave, Portland, OR (CRS); HealthPartners Institute, 8170 33rd Ave So 23301a, Minneapolis, MN (PJOC, JMSH). bostond@ochin.org.
Journal of the American Board of Family Medicine : JABFM
|September 13, 2023
Summary
A clinical decision support (CDS) system improved cardiovascular disease (CVD) risk management by increasing medication prescribing for hypertension and dyslipidemia. Prioritized recommendations from the CDS system enhanced prescribing patterns for CVD risk reduction.
Area of Science:
- Health Informatics
- Cardiovascular Medicine
- Clinical Decision Support Systems
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality, necessitating effective risk management strategies.
- Clinical decision support (CDS) systems offer potential to optimize prescribing patterns for CVD risk factors.
- Prioritization of CDS recommendations based on clinical benefit may enhance their impact on patient care.
Purpose of the Study:
- To evaluate the effect of a prioritized clinical decision support (CDS) system on prescribing for cardiovascular disease (CVD) risk factors.
- To determine if CDS recommendations, ordered by greatest to least benefit for CVD risk reduction, influence prescribing patterns.
Main Methods:
- A secondary analysis of cluster-randomized trial data from 70 community health centers between September 2018 and March 2020.
- Inclusion criteria: medication-naïve patients aged 40-75 with uncontrolled CVD risk factors, known diabetes, or CVD.
- Comparison of prescribing rates between CDS intervention clinics and control clinics for hypertension, dyslipidemia, and smoking cessation.
Main Results:
- Prescribing for hypertension was higher in intervention clinics using CDS compared to when dismissed, but not significantly different from control clinics.
- Prescribing for dyslipidemia and smoking cessation medications was significantly higher in intervention clinics using CDS compared to both dismissed and control encounters.
- Prescribing rates generally increased according to the prioritization level of CDS recommendations, except for dyslipidemia.
Conclusions:
- The use of a CDS system with prioritized recommendations significantly increased prescribing for most cardiovascular risk factors.
- Displaying prioritized actions within a CDS system can be an effective strategy for improving cardiovascular risk management.
- This approach highlights the potential of CDS to enhance the management of modifiable CVD risk factors in clinical practice.
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