Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial

doi:10.1136/bmj.320.7236.686

BMJ 2000;320:686-690 ( 11 March )

General Practice

Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial

Editorial by Jackson

Alan A Montgomery, MRC training fellow, ^a Tom Fahey, senior lecturer, ^a Tim J Peters, reader in medical statistics, ^b Christopher MacIntosh, technical assistant, ^a Deborah J Sharp, professor. ^a

^a Division of Primary Health Care, University of Bristol, Bristol BS8 2PR, ^b Department of Social Medicine, University of Bristol

Correspondence to: T Fahey tom.fahey{at}bristol.ac.uk

Objectives: To investigate the effect of a computer basedclinical decision support system and a risk chart on absolutecardiovascular risk, blood pressure, and prescribing of cardiovasculardrugs in hypertensivepatients.
Design: Cluster randomised controlledtrial.
Setting: 27 general practices inAvon.
Participants: 614 patients aged between 60 and 79 yearswith high bloodpressure.
Interventions: Patients were randomised to computer basedclinical decision support system plus cardiovascular risk chart;cardiovascular risk chart alone; or usualcare.
Main outcome measures: Percentage of patients in each group witha five year cardiovascular risk $>=$ 10%, systolic blood pressure,diastolic blood pressure, prescribing of cardiovasculardrugs.
Results: Patients in the computer based clinical decisionsupport system and chart only groups were no more likely to havecardiovascular risk reduced to below 10% than patients receivingusual care. Patients in the computer based clinical decision supportgroup were more likely to have a cardiovascular risk $>=$ 10% thanchart only patients, odds ratio 2.3 (95% confidence interval 1.1to 4.8). The chart only group had significantly lower systolicblood pressure compared with the usual care group (differencein means $-$ 4.6 mm Hg (95% confidence interval $-$ 8.4 to $-$ 0.8)). Reductionof diastolic blood pressure did not differ between the three groups.The chart only group were twice as likely to be prescribed twoclasses of cardiovascular drugs and over three times as likelyto be prescribed three or more classes of drugs compared withthe othergroups.
Conclusions: The computer based clinical decision supportsystem did not confer any benefit in absolute risk reduction orblood pressure control and requires further development and evaluationbefore use in clinical care can be recommended. Use of chart guidelinesare associated with a potentially important reduction in systolicbloodpressure.

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