Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.
Endocr Pract. 2024 Jul;30(7):657-662. doi: 10.1016/j.eprac.2024.04.014. Epub 2024 Apr 26.
Guidelines recommend screening all individuals with resistant hypertension for primary aldosteronism (PA) but less than 2% are screened. We aimed to develop a noninterruptive Best Practice Alert (BPA) to assess if its implementation in the electronic health record improved PA screening rates among individuals with apparent treatment-resistant hypertension (aTRH).
We implemented a noninterruptive BPA on 9/17/2022 at our ambulatory primary care, endocrinology, nephrology, and cardiology clinics. We assessed clinical parameters of people with aTRH before (9/17/2021-9/16/2022) and after (9/17/2022-9/16/2023) the BPA was implemented. The noninterruptive BPA embedded with an order set identified people with aTRH and recommended screening for PA if it was not previously performed.
There were 10 944 and 11 463 people with aTRH who attended office visits during the 12 months before and after the BPA implementation, respectively. There were no statistically significant differences in median age (P = .096), sex (P = .577), race (P = .753), and ethnicity (P = .472) between the pre- and post-BPA implementation groups. There was a significant increase in PA screening orders placed (227 [2.1%] vs 476 [4.2%], P < .001) and PA screening labs performed (169 [1.5%] vs 382 [3.3, P < .001) after BPA implementation. PA screening tests were positive in 26% (44/169) and 23% (88/382) of people in the pre- and post-BPA groups, respectively (P = .447).
Implementation of a real-time electronic health record BPA doubled the screening rate for PA among people with aTRH; however, the overall screening rate was low.
指南建议对所有耐药性高血压患者进行原发性醛固酮增多症（PA）筛查，但实际筛查率不足 2%。本研究旨在开发一种非中断式最佳实践警示（BPA），以评估其在电子健康记录中的实施是否能提高疑似治疗抵抗性高血压（aTRH）患者的 PA 筛查率。
我们于 2022 年 9 月 17 日在我们的门诊初级保健、内分泌、肾病和心脏病学诊所实施了一种非中断式 BPA。我们评估了 aTRH 患者在 BPA 实施前后（2021 年 9 月 17 日至 2022 年 9 月 16 日和 2022 年 9 月 17 日至 2023 年 9 月 16 日）的临床参数。非中断式 BPA 嵌入了一个医嘱集，可识别出 aTRH 患者，如果之前未进行过 PA 筛查，则建议进行 PA 筛查。
在 BPA 实施前的 12 个月内，分别有 10944 人和 11463 人因 aTRH 就诊，实施后的 12 个月内，分别有 10944 人和 11463 人因 aTRH 就诊。两组患者的中位年龄（P=0.096）、性别（P=0.577）、种族（P=0.753）和民族（P=0.472）无统计学差异。与 BPA 实施前相比，PA 筛查医嘱的数量（227[2.1%]与 476[4.2%]，P<0.001）和 PA 筛查实验室检查的数量（169[1.5%]与 382[3.3%]，P<0.001）显著增加。BPA 实施后，PA 筛查试验阳性的患者分别占 26%（44/169）和 23%（88/382）（P=0.447）。
实时电子健康记录 BPA 的实施使 aTRH 患者的 PA 筛查率翻了一番；然而，总体筛查率仍然较低。
