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

Michael Murray, Lisa E. Harris, J. Marc Overhage, Xiao Hua Zhou, George J. Eckert, Faye E. Smith, Nancy Nienaber Buchanan, Fredric D. Wolinsky, Clement J. McDonald, William M. Tierney

Research output: Contribution to journalArticle

86 Citations (Scopus)

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 × 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.

Original languageEnglish
Pages (from-to)324-337
Number of pages14
JournalPharmacotherapy
Volume24
Issue number3
DOIs
StatePublished - Mar 2004

Fingerprint

Treatment Failure
Pharmacists
Outpatients
Randomized Controlled Trials
Hypertension
Physicians
Health
Hospital Emergency Service
Hospitalization
Quality of Life
Blood Pressure
Drug Therapy
Electronic Health Records
Therapeutics
Internal Medicine
Drug-Related Side Effects and Adverse Reactions
Patient Satisfaction
Antihypertensive Agents
Prescriptions
Primary Health Care

Keywords

  • Computers
  • Hypertension
  • Practice guidelines
  • Randomized controlled trials

ASJC Scopus subject areas

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

Failure of Computerized Treatment Suggestions to Improve Health Outcomes of Outpatients with Uncomplicated Hypertension : Results of a Randomized Controlled Trial. / Murray, Michael; Harris, Lisa E.; Overhage, J. Marc; Zhou, Xiao Hua; Eckert, George J.; Smith, Faye E.; Buchanan, Nancy Nienaber; Wolinsky, Fredric D.; McDonald, Clement J.; Tierney, William M.

In: Pharmacotherapy, Vol. 24, No. 3, 03.2004, p. 324-337.

Research output: Contribution to journalArticle

Murray, M, Harris, LE, Overhage, JM, Zhou, XH, Eckert, GJ, Smith, FE, Buchanan, NN, Wolinsky, FD, McDonald, CJ & Tierney, WM 2004, 'Failure of Computerized Treatment Suggestions to Improve Health Outcomes of Outpatients with Uncomplicated Hypertension: Results of a Randomized Controlled Trial', Pharmacotherapy, vol. 24, no. 3, pp. 324-337. https://doi.org/10.1592/phco.24.4.324.33173
Murray, Michael ; Harris, Lisa E. ; Overhage, J. Marc ; Zhou, Xiao Hua ; Eckert, George J. ; Smith, Faye E. ; Buchanan, Nancy Nienaber ; Wolinsky, Fredric D. ; McDonald, Clement J. ; Tierney, William M. / Failure of Computerized Treatment Suggestions to Improve Health Outcomes of Outpatients with Uncomplicated Hypertension : Results of a Randomized Controlled Trial. In: Pharmacotherapy. 2004 ; Vol. 24, No. 3. pp. 324-337.
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