A COMPUTERIZED INTERVENTION TO DECREASE THE USE OF CALCIUM-CHANNEL BLOCKERS IN HYPERTENSION

OBJECTIVE: To determine whether a computer-assisted reminder would alt er prescribing habits for the treatment of hypertension in accordance with current clinical guidelines in a general internal medicine clinic . DESIGN:A randomized trial. SETTING: The General Internal Medicine Cl inic of the Veterans Affairs Puget Sound Health Care System, Seattle D ivision. PATIENTS/PARTICIPANTS: Clinic providers were randomized to a control group (n = 35) or intervention group (n = 36). We targeted the providers of patients being treated for hypertension with calcium cha nnel blockers, a class of drug not recommended for initial therapy. IN TERVENTION: An automated computer query identified eligible patients a nd their providers, A guideline reminder was placed in the charts of p atients of intervention providers; the charts of patients of control p roviders received no reminder. MEASUREMENTS AND MAIN RESULTS: During t he 5-month study period, 346 patients were seen by the 36 primary care providers (staff physicians, nurse practitioners, residents, and fell ows) in the intervention group, and 373 patients were seen by the 35 p roviders in the control group, Intervention providers changed 39 patie nts (11.3%) to other medications during the study period, compared wit h 1 patient (<1.0%) of control providers (p < .0001). For patients who se therapy was unchanged, providers noted angina in 23.1%, indications other than those for hypertension in 9.5%, intolerable adverse effect s with first-line therapy in 13.9%, and inadequate control with first- line therapy in 13.9%. Of those patients without provider-indicated co ntraindications, 23.6% were switched from calcium channel blockers to first-line agents during the intervention period.CONCLUSIONS: The use of a computerized, clinic-based intervention increased compliance with guidelines in the treatment of primary hypertension in general, and d ecreased the use of calcium channel blockers for the treatment of hype rtension in particular.