背景:尽管指南支持在心房颤动(AF)中使用抗血栓治疗,处方不足仍然存在。我们评估了计算机化临床决策支持(CDS)是否可以在初级保健中为AF患者提供基于指南的抗血栓治疗。
方法:这项针对CDS与常规护理(UC)的整群随机试验招募了来自新斯科舍省初级保健实践的参与者,跟随他们12个月。CDS工具计算出血和中风风险评分,并根据加拿大指南提供使用口服抗凝剂(OAC)的建议。
结果:从2014年6月14日至2016年12月15日,203名初级保健提供者(99UC,招募了104个可以使用高速互联网的CDS),招募1145名符合条件的患者(543UC,590CDS)分配给与其提供者相同的治疗部门。患者平均年龄为72.3岁;大多数为男性(350,64.5%UC,351,59.5%CDS)和来自农村地区(298,54.9%UC,315,CDS53.4%)。在基线,接受基于指南的OAC治疗的患者比例高于预期(373,68.7%UC,442,74.9%CDS;相对风险[RR]0.97(95%置信区间[CI],0.87-1.07;p=0.511))。12个月时,538名常规护理和570名CDS患者的处方数据可用,并且根据指南对更多的CDS患者进行了管理(415,77.1%UC,479,84.0%CDS;RR1.08(95%CI,1.01-1.15;p=0.024))。
结论:尽管基线率很高,初级保健提供者在12个月内获得CDS,根据国家指南,进一步优化了OAC治疗的处方,为可能有资格接受OAC治疗的AF患者提供.这表明CDS可以有效改善临床护理过程。
背景:临床试验NCT01927367。https://clinicaltrials.gov/ct2/show/NCT01927367?term=NCT01927367&draw=2&rank=1.
Despite guidelines supporting antithrombotic therapy use in atrial fibrillation (AF), under-prescribing persists. We assessed whether computerized clinical decision support (CDS) would enable guideline-based antithrombotic therapy for AF patients in primary care.
This cluster randomized
trial of CDS versus usual care (UC) recruited participants from primary care practices across Nova Scotia, following them for 12 months. The CDS tool calculated bleeding and stroke risk scores and provided recommendations for using oral anticoagulants (OAC) per Canadian guidelines.
From June 14, 2014 to December 15, 2016, 203 primary care providers (99 UC, 104 CDS) with access to high-speed Internet were recruited, enrolling 1,145 eligible patients (543 UC, 590 CDS) assigned to the same treatment arm as their provider. Patient mean age was 72.3 years; most were male (350, 64.5% UC, 351, 59.5% CDS) and from a rural area (298, 54.9% UC, 315, 53.4% CDS). At baseline, a higher than anticipated proportion of patients were receiving guideline-based OAC therapy (373, 68.7% UC, 442, 74.9% CDS; relative risk [RR] 0.97 (95% confidence interval [CI], 0.87-1.07; P = .511)). At 12 months, prescription data were available for 538 usual care and 570 CDS patients, and significantly more CDS patients were managed according to guidelines (415, 77.1% UC, 479, 84.0% CDS; RR 1.08 (95% CI, 1.01-1.15; P = .024)).
Notwithstanding high baseline rates, primary care provider access to the CDS over 12 months further optimized the prescribing of OAC therapy per national guidelines to AF patients potentially eligible to receive it. This suggests that CDS can be effective in improving clinical process of care.
Clinical Trials NCT01927367. https://clinicaltrials.gov/ct2/show/NCT01927367?term=NCT01927367&draw=2&rank=1.