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Clinical Decision Support Systems Using Home Blood Pressure Readings to Manage Patients With Hypertension: Scoping
Aminath Shiwaza Moosa1,2, Jun Jie Benjamin Seng1,3, Chirk Jenn Ng1,2,4
1SingHealth Polyclinics, Singapore, Singapore.
Insights
Clinical decision support systems (CDSSs) show promise for managing hypertension using home blood pressure (HBP) readings. However, gaps in development and implementation need addressing for optimal effectiveness and user satisfaction.
Area of Science:
- Medical Informatics
- Cardiology
- Health Services Research
Background:
- Home blood pressure (HBP) monitoring is crucial for hypertension management.
- Physicians face challenges in accessing, integrating, and interpreting HBP data for clinical decisions.
- Existing clinical decision support systems (CDSSs) for hypertension management show heterogeneity and gaps.
Purpose of the Study:
- To conduct a scoping review summarizing studies on CDSSs utilizing HBP readings for hypertension management.
- To identify frameworks, components, clinical outcomes, user experiences, and implementation processes of these CDSSs.
Main Methods:
- A comprehensive scoping review was performed using PubMed, Embase, and Scopus databases.
- Studies included adult patients with hypertension in outpatient settings using CDSSs integrated with HBP monitoring.
- Data extraction focused on theoretical frameworks, CDSS components, clinical outcomes, user experiences, and implementation.
Main Results:
- 33 studies were included, predominantly randomized controlled trials (64%) from the United States (49%).
- Most CDSSs were computerized (64%) using rule-based algorithms with alert triggers (91%).
- Studies reported improved blood pressure (86%) and medication adjustments (84%), but usability and access challenges were noted.
Conclusions:
- CDSSs offer potential benefits for hypertension management but require further development and implementation refinement.
- Future research should prioritize integrating robust frameworks, guideline alignment, improved data integration, and enhanced usability.
- Addressing these gaps is essential to maximize CDSS effectiveness, adoption, and user satisfaction in hypertension care.
Background:
Home blood pressure (HBP) is an important parameter that guides clinicians in managing hypertension in patients. However, in using these records to manage patients, physicians face challenges, particularly regarding access, integration, and interpretation of the records when making clinical decisions. Clinical decision support systems (CDSSs) have been proposed to address these challenges; however, current literature reveals significant heterogeneity and gaps in CDSSs used for hypertension management.
Objective:
This study aimed to summarize existing studies on CDSSs that use HBP readings to manage patients with hypertension.
Methods:
We conducted a scoping review, with searches performed in PubMed, Embase, and Scopus on April 1, 2024. The results were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. Studies that used CDSSs integrated with HBP monitoring among adult patients with hypertension in outpatient settings were included. Non-English studies were excluded. Outcomes assessed included the theoretical frameworks used for CDSS development, CDSS components (data capture, processing, and output), clinical outcomes, user experiences, and implementation processes.
Results:
Of the 5023 articles screened, 33 (0.66%) were included. Most of the studies were conducted in the United States (16/33, 49%) and were randomized controlled trials (21/33, 64%). Nearly two-thirds of the CDSSs (21/33, 64%) were computerized. Only 1 (3%) of the 33 studies reported using a theoretical framework for CDSS development. HBP recording and uploading were predominantly automatic (23/33, 70%). All computerized CDSSs (21/33, 64%) used rule-based algorithms, and most (19/21, 91%) incorporated alert triggers for results outside the reference range. More than a third of the studies (13/33, 39%) were based on hypertension guidelines. Among studies that reported outcomes, most reported improved blood pressure (25/29, 86%) and adjustment in antihypertensive medications (16/19, 84%). Patients and clinicians appreciated the convenience and remote monitoring (10/33, 30%) but reported challenges with usability and access to computerized CDSSs (2/21, 10%). Of the studies using noncomputerized CDSSs (12/33, 36%), all incorporated patient education, while nearly two-thirds of the studies using computerized CDSSs (13/21, 62%) did the same. Clinician training was reported in 5% (1/21) of the computerized CDSSs and 25% (3/12) of the noncomputerized CDSSs.
Conclusions:
While CDSSs hold promise for improving hypertension management, gaps remain in their development and implementation. Future efforts should focus on integrating robust frameworks; aligning with guidelines; enhancing manual data integration; and addressing usability to maximize effectiveness, adoption, and user satisfaction.
Trial Registration:
Open Science Framework 26zmn; https://osf.io/26zmn.
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