A clinical decision support system significantly reduced systolic blood pressure by an adjusted mean difference of 6.59 mm Hg compared to a chart-based support system at 12 months.
RCT (n=1,638)
Single-blind
Cluster randomization
Yes
Does a clinical decision support system improve systolic blood pressure reduction in adult hypertensive patients in resource-constrained primary health care settings?
A clinical decision support system significantly improved systolic blood pressure reduction and was more cost-effective compared to a chart-based support system in a resource-constrained primary care setting.
Effect estimate: Mean difference -6.59 mm Hg (95% CI -12.18 to -1.42)
Absolute Event Rate: -10.13% vs -3.59%
p-value: p=0.021
BACKGROUND: Randomized control trials from the developed world report that clinical decision support systems (DSS) could provide an effective means to improve the management of hypertension (HTN). However, evidence from developing countries in this regard is rather limited, and there is a need to assess the impact of a clinical DSS on managing HTN in primary health care center (PHC) settings. METHODS AND RESULTS: We performed a cluster randomized trial to test the effectiveness and cost-effectiveness of a clinical DSS among Indian adult hypertensive patients (between 35 and 64 years of age), wherein 16 PHC clusters from a district of Telangana state, India, were randomized to receive either a DSS or a chart-based support (CBS) system. Each intervention arm had 8 PHC clusters, with a mean of 102 hypertensive patients per cluster (n=845 in DSS and 783 in CBS groups). Mean change in systolic blood pressure (SBP) from baseline to 12 months was the primary endpoint. The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow-up, adjusted for age, sex, height, waist, body mass index, alcohol consumption, vegetable intake, pickle intake, and baseline differences in blood pressure, was -6. 59 mm Hg (95% confidence interval: -12. 18 to -1. 42; P=0. 021). The cost-effective ratio for CBS and DSS groups was 96. 01 and 36. 57 per mm of SBP reduction, respectively. CONCLUSION: Clinical DSS are effective and cost-effective in the management of HTN in resource-constrained PHC settings. CLINICAL TRIAL REGISTRATION URL: http: //www. ctri. nic. in. Unique identifier: CTRI/2012/03/002476.
Anchala et al. (Mon,) conducted a rct in Hypertension (n=1,638). Clinical Decision Support System (DSS) vs. Chart-based support (CBS) system was evaluated on Mean change in systolic blood pressure (SBP) from baseline to 12 months (Mean difference -6.59 mm Hg, 95% CI -12.18 to -1.42, p=0.021). A clinical decision support system significantly reduced systolic blood pressure by an adjusted mean difference of 6.59 mm Hg compared to a chart-based support system at 12 months.