计算机化临床决策支持,以改善中风预防疗法在心房的初级保健管理:一个集群随机试验
Jafna Cox1, Laura Hamilton2, Lehana Thabane3
1Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
American heart journal
|April 30, 2024
概括
计算机化临床决策支持 (CDS) 改进了基于指导方针的口服抗凝剂治疗,为初级保健中心房 (AF) 患者开处方. 该工具优化了OAC的使用,提高了12个月的患者护理流程.
科学领域:
- 心脏病学 心脏病学
- 医疗信息学 医疗信息学
- 主要护理医学 医疗保健
背景情况:
- 准则建议针对心房动 (AF) 进行抗血栓治疗,但处方不足仍然是一个挑战.
- 计算机化临床决策支持 (CDS) 系统为改善准则遵守提供了一个潜在的解决方案.
- 这项研究调查了CDS对口服抗凝剂 (OAC) 处方对初级保健AF患者的影响.
研究的目的:
- 评估CDS工具在促进AF患者基于指导方针的抗血栓治疗中的有效性.
- 评估CDS能否克服在初级保健机构中OAC持续处方不足的问题.
- 确定CDS对AF患者临床护理过程的影响.
主要方法:
- 一个集群随机试验,将CDS与初级保健实践中的常规护理 (UC) 进行比较.
- 参与者被跟踪了12个月,CDS工具提供了风险评分和OAC建议.
- 包括203名初级保健提供者和1,145名符合条件的AF患者.
主要成果:
- 在基线,高比例的患者 (68.7%UC,74.9%CDS) 接受了基于指南的OAC治疗.
- 12个月后,CDS组的患者数量显著增加,按照指导方针进行管理 (84.0% vs 77.1% UC).
- 在CDS组中,遵守指南的相对风险为1.08 (95% CI,1.01-1.15,P=.024).
结论:
- 在初级保健中,CDS有效地优化了对AF患者的OAC处方,即使基线率很高.
- 这些发现表明,CDS工具可以显著改善AF患者的临床护理过程.
- 实施CDS是一种可行的策略,可以提高AF患者管理指南的遵守率.
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