Murray Michael D, 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
Department of Medicine, Indiana University School of Medicine, USA.
Pharmacotherapy. 2004 Mar;24(3):324-37. doi: 10.1592/phco.24.4.324.33173.
To assess the effects of evidence-based treatment suggestions for hypertension made to physicians and pharmacists using a comprehensive electronic medical record system.
Randomized controlled trial with a 2 x 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).
Academic primary care internal medicine practice.
Seven hundred twelve patients with uncomplicated hypertension.
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.
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.
评估使用综合电子病历系统向医生和药剂师提供的高血压循证治疗建议的效果。
采用2×2析因设计的随机对照试验，涉及医生和药剂师干预，产生四组患者：仅医生干预、仅药剂师干预、医生和药剂师联合干预以及医生和药剂师均不干预（对照组）。
学术性初级保健内科诊所。
712例无并发症的高血压患者。
建议在用于开具门诊医嘱的计算机工作站上显示给医生，并在配药时显示给药剂师。主要终点是与健康相关的总体生活质量。次要终点包括症状特征和抗高血压药物的副作用、急诊就诊和住院次数、血压测量、患者对医生和药剂师的满意度、药物治疗依从性以及医疗费用。在对照组中，26%的患者根据治疗建议实施了护理变更。在干预组中，对建议的依从性较差，仅向药剂师显示建议的患者中有25%实施了治疗建议，仅向医生显示建议的患者中有29%实施了治疗建议，医生和药剂师均收到建议的组中有35%实施了治疗建议（p = 0.13）。在与健康相关的总体生活质量、症状和副作用特征、急诊就诊和住院次数、血压测量、费用或药物治疗依从性方面，组间差异无统计学意义且无临床相关性。
使用复杂的电子医生医嘱录入系统进行基于计算机的干预未能提高无并发症高血压患者对治疗建议的依从性或改善其治疗结果。
