Effects of a computerized decision support system in improving pharmacological management in high-risk cardiovascular patients: A cluster-randomized open-label controlled trial

This study was aimed to investigate the effects of computerized decision support system in improving the prescription of drugs for cardiovascular prevention. A total of 197 Italian general practitioners were randomly allocated to receive either the alerting computerized decision support system integrated into standard software (intervention arm) or the standard software alone (control arm). Data on 21230 patients with diabetes, 3956 with acute myocardial infarction, and 2158 with stroke were analysed. The proportion of patients prescribed with cardiovascular drugs and days of drug–drug interaction exposure were evaluated. Computerized decision support system significantly increased the proportion of patients with diabetes prescribed with antiplatelet drugs (intervention: +2.7% vs. control: +0.15%; p < 0.001) or lipidlowering drugs (+4.2% vs. +2.8%; p = 0.001). A statistically significant decrease in days of potential interactions has been observed only among patients with stroke (−1.2 vs. −0.5 days/person-year; p = 0.001). In conclusion, computerized decision support system significantly increased the use of recommended cardiovascular drugs in diabetic patients, but it did not influence the exposure to potential interactions

[1]  G. Mazzaglia,et al.  Secondary Prevention of Stroke in Italy: A Cross-Sectional Survey in Family Practice , 2003, Stroke.

[2]  P. Gimotty,et al.  The effect of adding Pap smear information to a mammography reminder system in an HMO: results of randomized controlled trial. , 2003, Preventive medicine.

[3]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[4]  D. Bates,et al.  Incidence and preventability of adverse drug events among older persons in the ambulatory setting. , 2003, JAMA.

[5]  R. Lawrenson,et al.  Clinical information for research; the use of general practice databases. , 1999, Journal of public health medicine.

[6]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[7]  Matthew H Samore,et al.  Clinical decision support and appropriateness of antimicrobial prescribing: a randomized trial. , 2005, JAMA.

[8]  L. Mantovani,et al.  Patterns of persistence with antihypertensive medications in newly diagnosed hypertensive patients in Italy: a retrospective cohort study in primary care , 2005, Journal of hypertension.

[9]  J Jespersen,et al.  Multicentre randomised study of computerised anticoagulant dosage. European Concerted Action on Anticoagulation. , 1998, Lancet.

[10]  Shah Ebrahim,et al.  European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (Version 2012) , 2012, International Journal of Behavioral Medicine.

[11]  Evangelos Evangelou,et al.  Intraclass correlation coefficients for cluster randomized trials in primary care: the cholesterol education and research trial (CEART). , 2005, Contemporary clinical trials.

[12]  David Parkin,et al.  Effect of computerised evidence based guidelines on management of asthma and angina in adults in primary care: cluster randomised controlled trial , 2002, BMJ : British Medical Journal.

[13]  Cordula Wagner,et al.  Potentially inappropriate medication use among elderly home care patients in Europe. , 2005, JAMA.

[14]  Shah Ebrahim,et al.  European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invit , 2007, European heart journal.

[15]  Robyn Tamblyn,et al.  Increasing the Detection and Response to Adherence Problems with Cardiovascular Medication in Primary Care through Computerized Drug Management Systems: A Randomized Controlled Trial , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[16]  L. Masserini.  L'uso dei farmaci in Italia , 2008 .

[17]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[18]  Karim Keshavjee,et al.  Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial , 2009, Canadian Medical Association Journal.

[19]  C. McDonald,et al.  Effects of computerized guidelines for managing heart disease in primary care , 2003, Journal of General Internal Medicine.

[20]  B. Stricker,et al.  Hospitalisations and emergency department visits due to drug–drug interactions: a literature review , 2007, Pharmacoepidemiology and drug safety.

[21]  C. Richards,et al.  Medication Use Leading to Emergency Department Visits for Adverse Drug Events in Older Adults , 2007, Annals of Internal Medicine.

[22]  G. Mazzaglia,et al.  Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases. , 2003, Journal of public health medicine.

[23]  P Michael Ho,et al.  Medication Adherence: Its Importance in Cardiovascular Outcomes , 2009, Circulation.

[24]  A. Hutchinson,et al.  Research methods used in developing and applying quality indicators in primary care , 2002, BMJ : British Medical Journal.

[25]  R. Verbrugge,et al.  Impact of Medication Adherence on Hospitalization Risk and Healthcare Cost , 2005, Medical care.

[26]  D. Tatro.  Drug Interaction Facts , 1990 .

[27]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[28]  R. Haynes,et al.  Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. , 1998, JAMA.

[29]  Liam Smeeth,et al.  Intraclass correlation coefficients for cluster randomized trials in primary care: data from the MRC Trial of the Assessment and Management of Older People in the Community. , 2002, Controlled clinical trials.

[30]  Irene Katzan,et al.  Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the , 2006, Stroke.

[31]  Alessandro Filippi,et al.  Effects of an automated electronic reminder in changing the antiplatelet drug-prescribing behavior among Italian general practitioners in diabetic patients: an intervention trial. , 2003, Diabetes care.

[32]  J. Jespersen,et al.  Multicentre randomised study of computerised anticoagulant dosage , 1998, The Lancet.

[33]  Shah Ebrahim,et al.  Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (Constituted by representatives of nine societies and by invited experts) , 2007 .

[34]  V. Chair,et al.  Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the , 2006, Circulation.

[35]  Charles Young,et al.  A randomized controlled trial of a computer-based physician workstation in an outpatient setting: implementation barriers to outcome evaluation. , 1996, Journal of the American Medical Informatics Association : JAMIA.

[36]  J. Hanley,et al.  The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[37]  Alessandro Filippi,et al.  Adherence to Antihypertensive Medications and Cardiovascular Morbidity Among Newly Diagnosed Hypertensive Patients , 2009, Circulation.

[38]  Peter Lindgren,et al.  Guidelines on diabetes, pre-diabetes, and cardiovascular diseases: executive summary , 2007 .

[39]  David Reeves,et al.  Improvements in quality of clinical care in English general practice 1998-2003: longitudinal observational study , 2005, BMJ : British Medical Journal.

[40]  Sjaak Brinkkemper,et al.  General practitioners’ attitudes towards decision-supported prescribing: An analysis of the Dutch primary care sector , 2013, Health Informatics J..

[41]  David L Buckeridge,et al.  Influence of physicians' management and communication ability on patients' persistence with antihypertensive medication. , 2010, Archives of internal medicine.

[42]  Marc Berg,et al.  Overriding of drug safety alerts in computerized physician order entry. , 2006, Journal of the American Medical Informatics Association : JAMIA.