Volume 24, Issue 3 p. 324-337

Failure of Computerized Treatment Suggestions to Improve Health Outcomes of Outpatients with Uncomplicated Hypertension: Results of a Randomized Controlled Trial

Michael D. Murray Pharm.D., M.P.H.

Corresponding Author

Michael D. Murray Pharm.D., M.P.H.

Department of Medicine, Indiana University School of Medicine

Regenstrief Institute

Department of Pharmacy Practice, Purdue University School of Pharmacy and Roudebush VA Medical Center

Regenstrief Institute, Regenstrief Health Center, Sixth Floor, 1050 Wishard Boulevard, Indianapolis, IN 46202–2872; e-mail: [email protected].Search for more papers by this author
Lisa E. Harris M.D.

Lisa E. Harris M.D.

Department of Medicine, Indiana University School of Medicine

Regenstrief Institute

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J. Marc Overhage M.D., Ph.D.

J. Marc Overhage M.D., Ph.D.

Department of Medicine, Indiana University School of Medicine

Regenstrief Institute

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Xiao-Hua Zhou Ph.D.

Xiao-Hua Zhou Ph.D.

Indianapolis, Indiana; the Department of Biostatistics, HSR&D Center of Excellence, VA Puget Sound Health Care System, University of Washington, Tacoma, Washington

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George J. Eckert M.A.S.

George J. Eckert M.A.S.

Department of Medicine, Indiana University School of Medicine

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Faye E. Smith M.A.

Faye E. Smith M.A.

Regenstrief Institute

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Nancy Nienaber Buchanan M.A.

Nancy Nienaber Buchanan M.A.

Regenstrief Institute

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Fredric D. Wolinsky Ph.D.

Fredric D. Wolinsky Ph.D.

St. Louis University School of Public Health, St. Louis, Missouri (Dr. Wolinsky).

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Clement J. McDonald M.D.

Clement J. McDonald M.D.

Department of Medicine, Indiana University School of Medicine

Regenstrief Institute

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William M. Tierney M.D.

William M. Tierney M.D.

Department of Medicine, Indiana University School of Medicine

Department of Pharmacy Practice, Purdue University School of Pharmacy and Roudebush VA Medical Center

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First published: 16 January 2012
Citations: 89

Abstract

Study Objective. To assess the effects of evidence-based treatment suggestions for hypertension made to physicians and pharmacists using a comprehensive electronic medical record system.

Design. Randomized controlled trial with a 2 times 2 factorial design of physician and pharmacist interventions, which resulted in four groups of patients: physician intervention only, pharmacist intervention only, intervention by physician and pharmacist, and intervention by neither physician nor pharmacist (control).

Setting. Academic primary care internal medicine practice.

Subjects. Seven hundred twelve patients with uncomplicated hypertension.

Measurements and Main Results. Suggestions were displayed to physicians on computer workstations used to write outpatient orders and to pharmacists when filling prescriptions. The primary end point was generic health-related quality of life. Secondary end points were symptom profile and side effects from antihypertensive drugs, number of emergency department visits and hospitalizations, blood pressure measurements, patient satisfaction with physicians and pharmacists, drug therapy compliance, and health care charges. In the control group, implementation of care changes in accordance with treatment suggestions was observed in 26% of patients. In the intervention groups, compliance with suggestions was poor, with treatment suggestions implemented in 25% of patients for whom suggestions were displayed only to pharmacists, 29% of those for whom suggestions were displayed only to physicians, and 35% of the group for whom both physicians and pharmacists received suggestions (p=0.13). Intergroup differences were neither statistically significant nor clinically relevant for generic health-related quality of life, symptom and side-effect profiles, number of emergency department visits and hospitalizations, blood pressure measurements, charges, or drug therapy compliance.

Conclusion. Computer-based intervention using a sophisticated electronic physician order-entry system failed to improve compliance with treatment suggestions or outcomes of patients with uncomplicated hypertension.