Point-of-service reminders for prescribing cardiovascular medications

  • 1 May 2005
    • journal article
    • research article
    • Vol. 11  (5) , 298-304
Abstract
Objectives: To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent Cardiovascular events. Study Design: Randomized controlled trial. Methods: Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were taxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups. Results: More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors or angiotensin 11 receptor blockers were dispensed in 7.1% of visits in the intervention group versus 5.7% in the control group (P.048) following the first patient-physician encounter. No significant difference was observed for statins (intervention, 8.1% vs control, 7.7%). Data for all patient-physician encounters and both medications were combined in logistic regression analysis. The odds ratio was 1.19 for a dispensed prescription in the intervention group and 1.54 for 2 or more visits versus 1 visit. Conclusions: An automated system that provides pertinent data and tailored recommendations for care at the point of service modestly increased prescription dispensing rates. Targeting patient-provider encounters to change provider behavior is challenging; however, even small effects can produce clinically important results over time.

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