Implementing clinical guidelines in the treatment of hypertension in general practice: Evaluation of patient outcome related to implementation of a computer-based clinical decision support system

Abstract

Implementation of clinical guidelines in the treatment of hypertensive patients in general practice by means of a CDSS and several other procedures for implementation did not affect patient outcome in any clinically significant way.

Clinical Decision Support Systems and Prevention

“…Twenty-six studies were from the U.S., 24,25,28,29,31,34,36,39,44,45,47,51–54,56,58,63,65,67,80–82,84,85,87 with the remaining studies conducted in Canada (five studies) 41,48,61,66,83 ; Europe (11 studies) 26,27,30,33,37,38,42,46,50,67,68 ; Australia (two studies) 32,60 ; and New Zealand (one study). 43 Most studies implemented CDSSs in outpatient practices; two studies 54,55 were in a hospital setting.…”

“…Nineteen studies 25,34,36,39,44,46–48,51,53–55,58,60,61,63,82,84,87 were conducted in practices with an academic affiliation, and three studies 25,28,80 took place in Veterans Affairs facilities. Studies focused on screening for CVD risk factors (six studies) 36,42,43,48,66,67 ; hypertension management (seven studies) 25,33,37,39,50,51,63 ; lipid management (six studies) 24,27,33,68,81,84 ; and diabetes management or CVD prevention among a diabetic population (15 studies). 26,29,30,38,41,44,45,47,52,58,60,65,82,85,87 Further, 11 studies 28,31,32,34,46,53–56,61,80 addressed other disease areas in addition to CVD prevention.…”

“…CDSS users were usually physicians (39 studies), 24–26,28,29,31,33,34,36–39,41,43–48,50–56,58,61,63,65–68,81–85,87 followed by nurses (12 studies) 24–26,29,36,41,45,47,50,61,63,84 ; physician assistants (five studies) 24,25,31,36,45 ; and pharmacists (two studies). 51,60 Most interventions used locally developed CDSSs (24 studies), 24,25,27,28,31,37–39,44–48,51,54,55,58,61,63,65,66,83,85,87 and were integrated within EHRs (29 studies). 24,28–30,32–34,37–39,42,43,46,50–52,54–56,63,66–68,80,82–85,87 Decision support was usually delivered to the clinician synchronously during patient visits (38 studies), 24–28,30,33,34,36–39,41–44,46,48,51–…”

“…51,60 Most interventions used locally developed CDSSs (24 studies), 24,25,27,28,31,37–39,44–48,51,54,55,58,61,63,65,66,83,85,87 and were integrated within EHRs (29 studies). 24,28–30,32–34,37–39,42,43,46,50–52,54–56,63,66–68,80,82–85,87 Decision support was usually delivered to the clinician synchronously during patient visits (38 studies), 24–28,30,33,34,36–39,41–44,46,48,51–56,58,60,61,65–68,80–85,87 and CDSS recommendations were usually system-initiated when delivered automatically without a clinician request (37 studies). 25–34,36,39,42,44–48,51–54,56,58,60,61,63,65–68,80–85 Most CDSSs were tailored to provide support for chronic disease management (24 studies) 24–29,37–39,41,44,45,51,52,…”

“…24,28–30,32–34,37–39,42,43,46,50–52,54–56,63,66–68,80,82–85,87 Decision support was usually delivered to the clinician synchronously during patient visits (38 studies), 24–28,30,33,34,36–39,41–44,46,48,51–56,58,60,61,65–68,80–85,87 and CDSS recommendations were usually system-initiated when delivered automatically without a clinician request (37 studies). 25–34,36,39,42,44–48,51–54,56,58,60,61,63,65–68,80–85 Most CDSSs were tailored to provide support for chronic disease management (24 studies) 24–29,37–39,41,44,45,51,52,58,63,65,80–85,87 ; pharmacotherapy (17 studies) 30,33,46,47,50,52,55,58,60,63,65,66,81,82,84,85,87 ; preventive care (15 studies) …”