Failure of computerized treatment suggestions to improve health outcomes of outpatients with uncomplicated hypertension: results of a randomized controlled trial

• HIT Description: decision support Ð clinical guidelines More info...
  
• Purpose of Study: assess the effects of evidence-based treatment suggestions aimed at physicians and pharmacists on compliance with suggests, health-related quality of life and secondary outcomes related to drug side effects, utilization and clinical measures.
  
• Years of study: 1994-1996
  
• Study Design: RCT
  
• Outcomes: impact on health care effectiveness and quality
  

• Settings: large, inner-city academic internal medicine practice affiliated with the Indiana University School of Medicine
• Intervention: 2X2 factorial design involving physician and pharmacist interventions. Physician practice sessions were randomized so that intervention session physicians received treatment suggestions for their hypertension patients based on electronic data entered on the visit date or previously. Additionally, half of patients in the physician intervention sessions and half from the physician control sessions were randomized so that pharmacists also received treatment suggestions when completing prescriptions.
• Evaluation Method: patient survey (health-related quality of life, patient satisfaction, drug side effects); administrative data on visits and hospitalizations; administrative data on blood pressure
• Description: Algorithms were developed based on JNC VI recommendations and local expert opinion so that care suggestions (Òsuggested ordersÓ) were displayed when providers accessed the computer-based ordering system for patients with hypertension. Pharmacists used a newly created pharmacist intervention recording system which provided them with care instructions as well when relevant.
• Strategy: dissemination of locally approved guidelines for managing hypertension; presentations at medical grand rounds; one-on-one meeting with each intervention pharmacist and physician regarding the intervention
• Barriers: ease of bypassing suggestions by using the ÒescapeÓ key
• Quality of Care and Patient Safety Outcome: Compliance with treatment suggestions did NOT differ significantly among groups nor were there differences in quality of life, blood pressure measurements or emergency room or hospital visits.