Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

Holt, Tim; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen; Friede, Tim; Stables, David

doi:10.3399/bjgp10x483904

Cited by 34 publications

(42 citation statements)

References 8 publications

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“…35, Nº 3, septiembre-diciembre discusión A partir de los resultados parece que ha existido impacto clínico con una reducción en la incidencia acumulada de los EA observados. Los resultados están en la línea de otros estudios que han encontrado que los recordatorios en pantalla, en el momento de tomar decisiones, son efectivos y mejoran los resultados clínicos [1][2][3][4][5][6] . Las reducciones absolutas de riesgo encontradas (alrededor del 2%), están por debajo de las encontradas por Shojania 1 en su revisión de los efectos de los recordatorios en prác-ticas médicas como prescribir fármacos específicos, advertir acerca de interacciones medicamentosas, proporcionar vacunaciones o indicar pruebas, que estaba entre un 3-4%.…”

Section: Materials Y Métodosunclassified

“…Cabe destacar así mismo diferentes estudios en los que se han probado los recordatorios para la toma decisiones en la prevención del tromboembolismo 2 , para instaurar la pauta de ácido acetilsalicílico al alta, recordar la vacunación del neumococo, de la gripe, la profilaxis con heparina 3 , la medida del riesgo cardiovascular 4 , el manejo de recomendaciones de guías clínicas 5 o la gestión de prescripciones de medicaciones concretas 6 ; también se han encontrado estudios sobre resultados de la informatización de protocolos y guías clíni-cas en diferentes situaciones clínicas como por ejemplo las úlceras por presión 7,8 . Pese a ello, lo cierto es que práctica-mente no existen estudios que analicen el uso de recordatorios en la práctica clínica de los cuidados y su efecto clínico en los pacientes, bien en resultados, o bien en la prevención de EA relacionados con cuidados incluido los EA relacionados con accesos vasculares.…”

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Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos

Viana

Núñez-Crespo

Martín-Merino

et al. 2012

Anales Sis San Navarra

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Fundamento. Medir el impacto clínico de la implantación de un sistema de recordatorios, que avise de los pacientes que tienen riesgo de presentar un evento adverso (EA) relacionado con los catéteres venosos periféricos. Métodos.A partir de los registros que se utilizan para seguimiento de los catéteres intravenosos se desarrolló una consulta automatizada que elabora un listado de los pacientes ingresados que incluye fecha de ingreso, fecha colocación, vía y tipo de vía. Se actualiza por turno en los ordenadores de la unidad. Se implantó en enero de 2010. Se ha realizado un estudio cuasiexperimental midiendo la incidencia acumulada de flebitis, extravasaciones y obstrucciones en los pacientes dados de alta en 2009 y en 2010. Se ha evaluado la asociación entre variables cualitativas con el test de Chi cuadrado, se ha estimado riesgo relativo (RR) y el número necesario de pacientes a tratar (NNT). conclusiones. Un listado de recordatorios que incluye los pacientes con acceso vascular y la fecha de éste, ha servido para disminuir el número de flebitis y extravasaciones, pero no las obstrucciones.Palabras clave. Sistemas recordatorios. Sistemas de registros médicos computarizados. Cateterización venosa perifé-rica. Eventos adversos. Hospitalización. abstract background. The main purpose of this paper is to measure the clinical impact of the implementation of a reminder system that would warn of patients who are at risk of presenting an adverse event (AE) related to the peripheral venous catheter.Method. On the basis of the registers used for monitoring intravenous catheters, an automated consultation was realized that elaborated a list of the patients admitted, including: date of admission, date of the insertion of the venous access device, and type of device. It was implanted in January 2010 and updated three times a day with the computers of the unit. A quasi-experimental study has measured the cumulative incidence of phlebitis, extravasation and obstructions in the patients registered in 2009 and 2010. The association between qualitative variables was evaluated with the Chisquared test, and relative risk (RR) and Number Needed to Treat (NNT) were estimated. conclusion. With the help of a reminder list (which includes the patients with vascular access and the date), there has been a decrease in the number of phlebitis and extravasations but not in the number of obstructions.

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Section: Materials Y Métodosunclassified

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Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos

Viana

Núñez-Crespo

Martín-Merino

et al. 2012

Anales Sis San Navarra

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“…The role of the GP in giving advice concerning lifestyle risks was considered specifically in two papers. 293,294 The first of these examined the use of 'pop-up' reminders on practice computers to improve GPs' awareness of patients with CVD risk factors. The 'nudge' screen would prompt the GP to offer advice and give information about lifestyle risk factors for the patient.…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

“…[285][286][287][288][289][290][291][292][293][294] Five papers [285][286][287][288][289] looked specifically at trying to alter patients' behaviour regarding the amount of exercise they took, their diet and other risk factors (e.g. smoking).…”

Section: Health Improvement Activities Undertaken In General Practicementioning

confidence: 99%

The organisation and delivery of health improvement in general practice and primary care: a scoping study

Peckham

Falconer

Gillam

et al. 2015

Health Serv Deliv Res

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BackgroundThis project examines the organisation and delivery of health improvement activities by and within general practice and the primary health-care team. The project was designed to examine who delivers these interventions, where they are located, what approaches are developed in practices, how individual practices and the primary health-care team organise such public health activities, and how these contribute to health improvement. Our focus was on health promotion and ill-health prevention activities.AimsThe aim of this scoping exercise was to identify the current extent of knowledge about the health improvement activities in general practice and the wider primary health-care team. The key objectives were to provide an overview of the range and type of health improvement activities, identify gaps in knowledge and areas for further empirical research. Our specific research objectives were to map the range and type of health improvement activity undertaken by general practice staff and the primary health-care team based within general practice; to scope the literature on health improvement in general practice or undertaken by health-care staff based in general practice and identify gaps in the evidence base; to synthesise the literature and identify effective approaches to the delivery and organisation of health improvement interventions in a general practice setting; and to identify the priority areas for research as defined by those working in general practice.MethodsWe undertook a comprehensive search of the literature. We followed a staged selection process involving reviews of titles and abstracts. This resulted in the identification of 1140 papers for data extraction, with 658 of these papers selected for inclusion in the review, of which 347 were included in the evidence synthesis. We also undertook 45 individual and two group interviews with primary health-care staff.FindingsMany of the research studies reviewed had some details about the type, process or location, or who provided the intervention. Generally, however, little attention is paid in the literature to examining the impact of the organisational context on the way services are delivered or how this affects the effectiveness of health improvement interventions in general practice. We found that the focus of attention is mainly on individual prevention approaches, with practices engaging in both primary and secondary prevention. The range of activities suggests that general practitioners do not take a population approach but focus on individual patients. However, it is clear that many general practitioners see health promotion as an integral part of practice, whether as individual approaches to primary or secondary health improvement or as a practice-based approach to improving the health of their patients. Our key conclusion is that there is currently insufficient good evidence to support many of the health improvement interventions undertaken in general practice and primary care more widely.Future ResearchFuture research on health improvement in general practice and by the primary health-care team needs to move beyond clinical research to include delivery systems and be conducted in a primary care setting. More research needs to examine areas where there are chronic disease burdens – cancer, dementia and other disabilities of old age. Reviews should be commissioned that examine the whole prevention pathway for health problems that are managed within primary care drawing together research from general practice, pharmacy, community engagement, etc.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…This was effective in increasing the amount of information recorded, but did not significantly change patient-related cardiovascular outcomes over 2 years. 1 This is not surprising, as we know that computerised prompts and reminders can be effective in improving the process of clinical care, and indeed may improve patient-related outcomes if the study is adequately powered. 2 The interesting aspect of this study is the use of the eHR system itself to manage the allocation to study group, the intervention, and the data collection, thus enabling a PhD project to conduct a 77 000 patient-year randomised controlled trial.…”

mentioning

confidence: 99%

General practice at the cutting edge of information technology, or failing to keep pace?

Delaney

2010

Br J Gen Pract

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Automated electronic reminders to facilitate primary cardiovascular disease prevention: randomised controlled trial

Cited by 34 publications

References 8 publications

Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos

Impacto de la implantación de recordatorios para disminuir eventos adversos en pacientes con accesos venosos periféricos

The organisation and delivery of health improvement in general practice and primary care: a scoping study

General practice at the cutting edge of information technology, or failing to keep pace?

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