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A computerized intervention to decrease the use of calcium channel blockers in hypertension

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Abstract

Objective

To determine whether a computer-assisted reminder would alter prescribing habits for the treatment of hypertension in accordance with current clinical guidelines in a general internal medicine clinic.

Design

A randomized trial.

Setting

The General Internal Medicine Clinic of the Veterans Affairs Puget Sound Health Care System, Seattle Division.

Patients/Participants

Clinic providers were randomized to a control group (n=35) or intervention group (n=36). We targeted the providers of patients being treated for hypertension with calcium channel blockers, a class of drug not recommended for initial therapy.

Intervention

An automated computer query identified eligible patients and their providers. A guideline reminder was placed in the charts of patients of intervention providers; the charts of patients of control providers received no reminder.

Measurements and main results

During the 5-month study period, 346 patients were seen by the 36 primary care providers (staff physicians, nurse practitioners, residents, and fellows) in the intervention group, and 373 patients were seen by the 35 providers in the control group. Intervention providers changed 39 patients (11.3%) to other medications during the study period, compared with 1 patient (<1.0%) of control providers (p<.0001). For patients whose therapy was unchanged, providers noted angina in 23.1%, indications other than those for hypertension in 9.5%, intolerable adverse effects with first-line therapy in 13.9%, and inadequte control with first-line therapy in 13.9%. Of those patients without provider-indicated contraindications, 23.6% were switched from calcium channel blockers to first-line agents during the intervention period.

Conclusions

The use of a computerized, clinic-based intervention increased compliance with guidelines in the treatment of primary hypertension in general, and decreased the use of calcium channel blockers for the treatment of hypertension in particular.

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References

  1. Avorn J, Soumerai S. Improving drug-therapy decisions through education outreach: a randomized, controlled trial of academically based “detailing.” N Engl J Med. 1983;308:1457–63.

    Article  PubMed  CAS  Google Scholar 

  2. Schaffner W, Ray WA, Federspiel CF. Improving antibiotic prescribing in office practice: a controlled trial of three education methods. JAMA. 1983;250:1728–32.

    Article  PubMed  CAS  Google Scholar 

  3. Ray WA, Fink R, Schaffner W, Federspiel CF. Improving antibiotic prescribing in outpatient practice: non-association of outcome with prescriber characteristics and measures of receptivity. Med Care. 1985;23:1307–13.

    Article  PubMed  CAS  Google Scholar 

  4. West SK, Brandon BM, Stevens AM, et al. Drug utilization review in an HMO, I: introduction and examples of methodology. Med Care. 1977;15:505–14.

    Article  PubMed  CAS  Google Scholar 

  5. Hersey CO, Porter DK, Breslau D, Cohen DI. Influence of simple computerized feedback on prescription changes in an ambulatory clinic: a randomized, clinical trial. Med Care. 1986;24:472–81.

    Article  Google Scholar 

  6. Gehlback SH, Wilkinson WE, Hammond WE, et al. Improving drug prescribing in a primary care practice. Med Care. 1984;22: 193–201.

    Article  Google Scholar 

  7. Groves R. Therapeutic drug-use review for the Florida Medicaid program. Am J Hosp Pharm. 1985;42:316–9.

    PubMed  CAS  Google Scholar 

  8. Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure. The Fifth Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC V). Arch Intern Med. 1993;153:154–83.

    Article  Google Scholar 

  9. Dahlof B, Lindholm LH, Hansson L, Schersten B, Ekbom T, Wester PO. Morbidity and mortality in the Swedish trial in old patients with hypertension (STOP-Hypertension). Lancet. 1991;338: 1281–5.

    Article  PubMed  CAS  Google Scholar 

  10. Maniolio TA, Cutler JA, Furberg CD, Psaty BM, Whelton PK, Applegate WB. Trends in the pharmacologic management of hypertension in the United States. Arch Intern Med. 1995;155:829–37.

    Article  Google Scholar 

  11. Psaty BM, Heckber SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995;274(8):620–5.

    Article  PubMed  CAS  Google Scholar 

  12. Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92(5):1326–31.

    PubMed  CAS  Google Scholar 

  13. Borhani NO, Mercuri M, Borhani PA, et al. Final outcome results of the multicenter isradipine diuretic atherosclerosis study (MIDAS). JAMA. 1996;276(10):785–91.

    Article  PubMed  CAS  Google Scholar 

  14. Reiber GE, McDonnell MB, Schleyer AM, et al. A comprehensive system for quality improvement in ambulatory care: assessing quality of diabetes care. Patient Educ Couns. 1995;26:337–41.

    Article  PubMed  CAS  Google Scholar 

  15. Noreen EW. Computer Intensive Methods for Testing Hypotheses. New York, NY: John Wiley & Sons; 1989.

    Google Scholar 

  16. Hilleman DE, Mohiuddin SM, Lucas BD, et al. Cost-minimization analysis of initial antihypertensive therapy in patients with mild-to-moderate essential diastolic hypertension. Clin Ther. 1994; 16(1):88–102.

    PubMed  CAS  Google Scholar 

  17. Neaton JD, Grimm RH, Prineas RJ, et al. Treatment of mild hypertension: final results. JAMA. 1993;270(6):713–24.

    Article  PubMed  CAS  Google Scholar 

  18. Boissel JP, Collet JP, Leon L, et al. A randomized comparison of the effect of four antihypertensive monotherapies on the subjective quality of life in previously untreated asymptomatic patients: field trial in general practice. J Hypertens. 1995;13:1059–67.

    Article  PubMed  CAS  Google Scholar 

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Rossi, R.A., Every, N.R. A computerized intervention to decrease the use of calcium channel blockers in hypertension. J GEN INTERN MED 12, 672–678 (1997). https://doi.org/10.1046/j.1525-1497.1997.07140.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1997.07140.x

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