The implementation of a clinical decision support system (CDSS) offers an innovative approach to improving hypertension treatment in China. A recent trial across 94 primary care practices in four urban regions demonstrated that technology can help close the gap between medical guidelines and real-world practice, particularly for chronic conditions like hypertension.
The trial was conducted from August 2019 to July 2022 and involved over 12,000 participants with hypertension. The aim was to assess how well CDSS could improve adherence to guideline-based antihypertensive treatment. “This system was built into existing electronic health records and offered recommendations for starting, adjusting, or switching antihypertensive treatments,” said Dr. Jiali Song, one of the lead researchers. The trial’s design ensured that half of the practices used the CDSS, while the other half continued with usual care.
Measurable Outcomes
One of the key outcomes measured was the proportion of visits where appropriate guideline-accordant treatment was provided. According to the trial results, this proportion was significantly higher in the group using the CDSS. “We saw a 15.2% absolute difference in the provision of appropriate care between the intervention and control groups,” noted Dr. Xiuling Wang. This figure translates into 77.8% of visits in the CDSS group receiving appropriate care versus only 62.2% in the usual care group.
The researchers also measured reductions in systolic blood pressure, which were greater in the CDSS group. “Participants in the intervention group experienced a modest but important reduction of 1.6 mm Hg compared to the control group,” explained Dr. Wenjun Ma, another study investigator. Additionally, the proportion of participants who had their blood pressure controlled below 140/90 mm Hg was slightly higher in the CDSS group (69.0% vs. 64.6%).
Addressing Adverse Effects
Safety was a critical concern in this trial. The researchers closely monitored potential adverse events such as syncope, symptomatic hypotension, or bradycardia. “Adverse effects related to antihypertensive treatments were rare in both groups, and we saw no significant safety concerns,” said Dr. Lili Wang. This finding underscores the safety of integrating CDSS into routine care for hypertensive patients.
Promising Future Applications
The success of the CDSS trial has significant implications for primary care in China and beyond. “This system is scalable and could be adapted to other chronic diseases,” stated Dr. Jing Li, highlighting the broader potential of clinical decision support in transforming healthcare delivery. The trial also demonstrated how digital tools could support physicians in delivering evidence-based care, particularly in resource-constrained settings.
The results provide hope that technology, when effectively implemented, can not only improve health outcomes but also ease the burden on healthcare professionals. “Our findings indicate that the integration of CDSS into primary care can help improve guideline adherence and ultimately patient outcomes,” emphasized Dr. Jiguang Wang.
CDSS represents a significant step forward in addressing the complexities of chronic disease management in primary care, particularly for hypertension, which remains a global health challenge.
Citation:
Song J, Wang X, Wang B, Ge Y, Bi L, Jing F, et al. Learning implementation of a guideline based decision support system to improve hypertension treatment in primary care in China: pragmatic cluster randomised controlled trial. BMJ. 2023;386. doi:10.1136/bmj-2023-079143
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