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.
Similar content being viewed by others
References
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.
Schaffner W, Ray WA, Federspiel CF. Improving antibiotic prescribing in office practice: a controlled trial of three education methods. JAMA. 1983;250:1728–32.
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.
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.
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.
Gehlback SH, Wilkinson WE, Hammond WE, et al. Improving drug prescribing in a primary care practice. Med Care. 1984;22: 193–201.
Groves R. Therapeutic drug-use review for the Florida Medicaid program. Am J Hosp Pharm. 1985;42:316–9.
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.
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.
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.
Psaty BM, Heckber SR, Koepsell TD, et al. The risk of myocardial infarction associated with antihypertensive drug therapies. JAMA. 1995;274(8):620–5.
Furberg CD, Psaty BM, Meyer JV. Nifedipine: dose-related increase in mortality in patients with coronary heart disease. Circulation. 1995;92(5):1326–31.
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.
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.
Noreen EW. Computer Intensive Methods for Testing Hypotheses. New York, NY: John Wiley & Sons; 1989.
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.
Neaton JD, Grimm RH, Prineas RJ, et al. Treatment of mild hypertension: final results. JAMA. 1993;270(6):713–24.
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.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
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
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.1997.07140.x