Bonnevie L et al. 2005 "The use of computerized decision support systems in preventive cardiology-principal results from the national PRECARD survey in Denmark."
Reference
Bonnevie L, Thomsen T, Jorgensen T. The use of computerized decision support systems in preventive cardiology-principal results from the national PRECARD survey in Denmark. Eur J Cardiovasc Prev Rehabil 2005;12(1):52-55.
Abstract
"Background: The [risk management tool] program has been used for electronic cardiovascular disease (CVD) risk assessment and management in Denmark since 1999. The use of and attitudes toward the program are reported. Design and methods: Using an Internet and postal survey to all Danish general practitioners, a total of 592 Danish general practitioners [GPs] participated in the Internet part of the survey (response rate 19%) and 291 in the postal survey (response rate 73%). Results: In all, 21.5% of the GPs use [the system], whereas 10% are ex-users. The program is used on average once a week and 64% of the users report that [the system] prolongs the consultation somewhat or a lot. Both users and ex-users perceive the program to have a favourable effect on the patients, and as an improvement to the dialogue between GP and patient. Reasons for no longer using the program are varied, such as technical problems and lack of routine with the program. Conclusions: Our results indicate that an electronic risk management tool like [this one] is perceived as a quality improvement in preventive cardiology in primary care. However the use of the program is not optimal and it may prolong the consultation."
Objective
To report the use of and attitudes toward an electronic risk management tool on cardiovascular disease risk assessment and management.
Tools Used
Type Clinic
Primary care
Size
not applicable
Geography
Urban, suburban, and rural
Other Information
All 3,568 registered general practitioners in Denmark were contacted to participate in the survey in August and September 2003.
Type of Health IT
Informational resource
Type of Health IT Functions
"The [risk management tool] calculates the absolute risk of coronary heart disease (CHD), myocardial infarction, stroke or any fatal event in patients under the age of 70 and without existing [cardiovascular disease]. The calculations are based on sex, age, and family predisposition for CHD, diabetes, previous heart disease, systolic blood pressure, total cholesterol, high-density lipoprotein (HDL) cholesterol, body mass index, and smoking. The program uses the Copenhagen Risk Score, which is based on a pooling of two Danish population studies, the Glostrup Population Studies and Copenhagen City Heart Study (n=11 765). Present risk is shown in a bar chart together with the expected risk if treatment goals are obtained. The estimation of the effect of intervention is based on results from large randomized clinical trials. In a pie chart the distribution of modifiable risk factors are shown. Based on the individual risk profile ... computer-generated health advice is compiled and can be printed [for] the patient."
Workflow-Related Findings
"[M]ost general practitioners perceived the program to have a positive effect on the patients' motivation for lifestyle change and on the patients' understanding of their own CHD risk. The same questions were also asked to the [former] users of the program and a similar pattern was observed, for example, reporting positive effect on motivation (68%, n=32) and risk understanding (77%, n=36)."
"Almost all general practitioners found that the use of the [risk management tool] improved the dialogue (93%, n=162) as well as focus the consultation on the most important risk factors (99%, n=172)."
"The most prominent reason for [ceasing] use was that [the risk management tool] does not communicate with other medical program and thus the general practitioner has to type patient data twice. Another factor that greatly contributed to GPs abandoning the program was difficulties with establishing the use as part of the clinical routine. The perception that the program gives too much focus on risk in the consultation influenced the decision to stop using the program for more than half of the [former] users, however only 15% (n=5) found this to be of great importance. All in all the ex-users did not find the program interfered with their decision-making (12.5%, n=5) nor that it made the patients more worried (11%, n=5). Only 11% (n=5) stated that the prolonging of the consultation contributed greatly to the fact that they no longer use" the program.
"[T]he [risk management tool] had been installed on 31.5% of all Danish general practitioners' computers since 1999, and more than two-thirds of these used the program in 2003 ... The [system] was used on average 4.1 times a month."
Users of the risk management tool "spent 14% more time on their consultations compared to 'never users', but this difference was not significant (P=0.056).... But at the same time the program was reported to prolong the consultation time 'somewhat or a lot' by 61% (n=108) of the...users."
Study Design
Only postintervention (no control group)
Study Participants
A total of 592 Danish general practitioners participated in the Internet part of the survey (response rate of 19 percent) and 291 in the postal survey (response rate of 73 percent).