Difference between revisions of "Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial"
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| − | == | + | == Introduction == |
| − | + | In the western world, Clinical Decision Support (CDS) has proved to be successful in helping doctors treating and managing hypertension (HTN) patients, however there is not much information on how effective a CDS system would be in a developing country. India is currently experiencing a strong need for more providers in the Primary Health Care (PHC) setting and are also experiencing an increase in healthcare IT available. Therefore there is a chance to get some more insight of how effective CDS could be in lower-income countries at aiding in managing hypertension. | |
== Methods == | == Methods == | ||
| − | + | PHC physicians in India were randomized to receive the Decision Support System (DSS) or Chart-based Support (CBS). | |
| − | The | + | The Decision Support System (DSS) is a software that was previously created to help physicians evaluate and classify their patient’s risk factors of developing Cardiovascular disease, calculate and provide drug-management guidelines and alert the physician to counsel the patient on behavioral changes. |
| + | The Chart-based Support (CBS) is the same guidelines as those integrated in the DSS software, but printed on a poster and hung where the physician met with his/her patients. | ||
| + | The DSS and CBS Physicians’ patients who gave consent, were between 35 to 64 years old and had a systolic blood pressure (SBP) of 140+ mm HG and/or diastolic blood pressure (DBP) of 90+ mm HG were included in this study. The both sets of participants’ data was collected and the SBP at 0 and 12 months were compared. | ||
| + | In order to calculate both the DSS’s and the CBS’s cost-effectiveness, the authors used Drummond’s 10-point check list. | ||
== Results == | == Results == | ||
| − | + | According to the authors’ results, the physicians using the DSS agreed with the DSS suggestions 93% of the time during the study. | |
| − | + | The unadjusted mean SBP for the DSS group was calculated for both groups at 0 months and 12 months: | |
| − | + | DSS Group 0 months: 151.1 CBS Group 0 Months: 148.2 | |
| − | + | DSS Group 12 Months: 139.9 CBS Group 12 Months: 144.7 | |
| − | + | The unadjusted mean DBP for the DSS group was calculated for both groups at 0 months and 12 months: | |
| − | + | DSS Group 0 months: 89.7 CBS Group 0 Months: 88.4 | |
| − | + | DSS Group 12 Months: 84.3 CBS Group 12 Months: 86.3 | |
| − | + | The cost-effectiveness ratio (CER) for the DSS group was $36.57 per mm reduction in SBP and the CER for the CBS group was $96.01 per mm reduction in SBP. | |
| − | 0. | + | |
| − | + | ||
| − | + | ||
| − | + | ||
== Discussion == | == Discussion == | ||
| − | + | A significant improvement was seen in the DSS group for both the unadjusted mean SBP, but the improvement for the CBS group was less significant. This improvement is more significant than previous DSS studies and the authors attribute this to the shortage of providers in PHC settings and specialization of the DSS. | |
| − | + | ||
| − | + | ||
== Commentary == | == Commentary == | ||
| − | In this article, the authors | + | In this article, the authors wanted to shed some light on the effectiveness of a CDS system in low to middle income countries. While I think this is interesting, this study only included one country’s result and I would caution not to base all low-middle income countries on these results. |
| − | + | ||
== References == | == References == | ||
<references/> | <references/> | ||
Revision as of 00:24, 6 March 2015
This is a review for Raghupathy Anchala, MD, PhD, Stephen Kaptoge, PhD, Hira Pant, MA, Emanuele Di Angelantonio, MD, PhD, Oscar H. Franco, MD, PhD, and D. Prabhakaran's, MD, DM, MSc Creating Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial.[1]
Introduction
In the western world, Clinical Decision Support (CDS) has proved to be successful in helping doctors treating and managing hypertension (HTN) patients, however there is not much information on how effective a CDS system would be in a developing country. India is currently experiencing a strong need for more providers in the Primary Health Care (PHC) setting and are also experiencing an increase in healthcare IT available. Therefore there is a chance to get some more insight of how effective CDS could be in lower-income countries at aiding in managing hypertension.
Methods
PHC physicians in India were randomized to receive the Decision Support System (DSS) or Chart-based Support (CBS). The Decision Support System (DSS) is a software that was previously created to help physicians evaluate and classify their patient’s risk factors of developing Cardiovascular disease, calculate and provide drug-management guidelines and alert the physician to counsel the patient on behavioral changes. The Chart-based Support (CBS) is the same guidelines as those integrated in the DSS software, but printed on a poster and hung where the physician met with his/her patients. The DSS and CBS Physicians’ patients who gave consent, were between 35 to 64 years old and had a systolic blood pressure (SBP) of 140+ mm HG and/or diastolic blood pressure (DBP) of 90+ mm HG were included in this study. The both sets of participants’ data was collected and the SBP at 0 and 12 months were compared. In order to calculate both the DSS’s and the CBS’s cost-effectiveness, the authors used Drummond’s 10-point check list.
Results
According to the authors’ results, the physicians using the DSS agreed with the DSS suggestions 93% of the time during the study. The unadjusted mean SBP for the DSS group was calculated for both groups at 0 months and 12 months: DSS Group 0 months: 151.1 CBS Group 0 Months: 148.2 DSS Group 12 Months: 139.9 CBS Group 12 Months: 144.7 The unadjusted mean DBP for the DSS group was calculated for both groups at 0 months and 12 months: DSS Group 0 months: 89.7 CBS Group 0 Months: 88.4 DSS Group 12 Months: 84.3 CBS Group 12 Months: 86.3 The cost-effectiveness ratio (CER) for the DSS group was $36.57 per mm reduction in SBP and the CER for the CBS group was $96.01 per mm reduction in SBP.
Discussion
A significant improvement was seen in the DSS group for both the unadjusted mean SBP, but the improvement for the CBS group was less significant. This improvement is more significant than previous DSS studies and the authors attribute this to the shortage of providers in PHC settings and specialization of the DSS.
Commentary
In this article, the authors wanted to shed some light on the effectiveness of a CDS system in low to middle income countries. While I think this is interesting, this study only included one country’s result and I would caution not to base all low-middle income countries on these results.
References
- ↑ Raghupathy Anchala, MD, PhD, Stephen Kaptoge, PhD, Hira Pant, MA, Emanuele Di Angelantonio, MD, PhD, Oscar H. Franco, MD, PhD, and D. Prabhakaran's, MD, DM, MSc Creating Evaluation of effectiveness and cost-effectiveness of a clinical decision support system in managing hypertension in resource constrained primary health care settings: results from a cluster randomized trial. J Am Heart Assoc. 2015 Jan 5;4(1):e001213. doi: 10.1161/JAHA.114.001213. http://www.ncbi.nlm.nih.gov/pubmed/25559011
