Computer-Assisted versus Oral-and-Written History Taking for the Prevention and Management of Cardiovascular Disease: a Systematic Review of the Literature

Abstract

A B ST R AC T Background and objectives: CVD is an important global healthcare issue; it is the leading cause of global mortality, with an increasing incidence identified in both developed and developing countries. It is also an extremely costly disease for healthcare systems unless managed effectively. In this review we aimed to: -Assess the effect of computer-assisted versus oral-and-written history taking on the quality of collected information for the prevention and management of CVD.-Assess the effect of computer-assisted versus oral-and-written history taking on the prevention and management of CVD. Methods: A systematic review of randomised controlled trials that included participants of 16 years or older at the beginning of the study, who were at risk of CVD (prevention) or were either previously diagnosed with CVD (management). We searched all major databases. We assessed risk of bias using the Cochrane Collaboration tool. Results: Two studies met the inclusion criteria. One comparing the two methods of history-taking for the prevention of cardiovascular disease n = 75. The study shows that generally the patients in the experimental group underwent more laboratory procedures, had more biomarker readings recorded and/or were given (or had reviewed), more dietary changes than the control group. The other study compares the two methods of history-taking for the management of cardiovascular disease (n = 479). The study showed that the computerized decision aid appears to increase the proportion of patients who responded to invitations to discuss CVD prevention with their doctor. The ComputerAssisted History Taking Systems (CAHTS) increased the proportion of patients who discussed CHD risk reduction with their doctor from 24% to 40% and increased the proportion who had a specific plan to reduce their risk from 24% to 37%. Discussion: With only one study meeting the inclusion criteria, for prevention of CVD and one study for management of CVD we did not gather sufficient evidence to address all of the objectives of the review. We were unable to report on most of the secondary patient outcomes in our protocol. Conclusions: We tentatively conclude that CAHTS can provide individually-tailored information about CVD prevention. However, further primary studies are needed to confirm these findings. We cannot draw any conclusions in relation to any other clinical outcomes at this stage. There is a need to develop an evidence base to support the effective development and use of CAHTS in this area of practice. In the absence of evidence on effectiveness, the implementation of computer-assisted history taking may only rely on the clinicians' tacit knowledge, published monographs and viewpoint articles.

The impact of automatic history-taking software on data quality in the cardiology outpatient clinic: Retrospective observational study

“… 14 , 15 Despite promising results, CAHTS is rarely used in clinical practice. 16 CAHTS systems are currently designed mainly to support the transactional needs of administrators and invoice issuers rather than to foster the relationship between patients and health professionals. 17 …”

Automated history-taking improves data quality for clinical decision-making in outpatient cardiology examinations (Preprint)

“…CAHTS has the potential to improve outcomes and quality of care, provide cost savings and increase patients' involvement in their own healthcare 14,15 . Despite promising results, CAHTS is rarely used in clinical practice 16 .…”

Use of Self-Reported Computerized Medical History Taking for Acute Chest Pain in the Emergency Department – the Clinical Expert Operating System Chest Pain Danderyd Study (CLEOS-CPDS): Prospective Cohort Study

“…However, there are only occasional studies on CHT in the acute cardiology setting or for ED patients with an acute complaint [ 20 , 21 ]. Indeed, the authors of a recent review for CHT in the management of cardiovascular disease concluded that there is a need to develop an evidence base for the use of CHT in this area of practice [ 22 ].…”