Randomised controlled trial of computer assisted management of hypertension in primary care

• HIT Description: Computerized physician and patient feedback system for the management of hypertension. More info...
  
• Purpose of Study: Assess if general practitioners would obtain better outcomes for patients with hypertension using a computer than doctors not using a computer.
  
• Years of study: Not Available
  
• Study Design: RCT
  
• Outcomes: Impact on health care effectivness/quality, Impact on efficiency, utilization, costs
  

• Settings: The study was conducted at the practices of six family physicians in Toronto, Canada.
• Intervention: Physicians were randomized to two treatment strategies: "Test" physicians completed a data collection form after each visit from a patient with hypertension and mailed the forms to the test centre for processing. Computer feedback on management was mailed to the doctors, and letters were mailed to patients to remind them of appointments. "Control" doctors filled out the same data collection forms as test physicians, but neither doctors nor patients received computer feedback.
• Evaluation Method: Measures were assessment and control of hypertension, number of patients seen, and length of follow up.
• Quality of Care and Patient Safety Outcome: For patients with "moderate" hypertension of a baseline diastolic pressure of greater than 104 mm Hg the mean score of the last recorded pressure was below the goal of 90 mm Hg in "Test" practices (88.5 mm Hg), but it failed to reach this goal in "Control" practices (93.3 mm Hg). A greater average reduction of diastolic pressure was achieved in "Test" practices (test 21.7 mm Hg, control 16.7 mm Hg). Though patients with "moderate" hypertension were better controlled in "Test" practices than in "Control" practices, the patients in test practices visited their doctors less often ("Test" 13.3 visits per patient-year, "Control" 17.4 visits). Among patients with newly detected hypertension "Test" practices achieved a greater reduction in diastolic pressure than "Control" practices ("Test" 15.1 mm Hg v "Control" 11.3 mm Hg) and more sustained control of hypertension ("Test" 323 days per patient-year with a diastolic pressure of 90 mm Hg or less v "Control" 259 days). In ÒTestÓ practices there were a smaller percen
• Changes in efficiency and productivity: ÒTestÓ physicians saw more patients per practice than ÒControlÓ doctors (ÒTestÓ 50 patients, ÒControlÓ 40). The length of follow up was significantly longer in ÒTestÓ practices (ÒTestÓ 199 days, ÒControlÓ 167).