Evaluation of Effectiveness and Cost‐Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial
This is a review for a study done by Raghupathy Anchala, MD, PhD; Stephen Kaptoge, PhD; Hira Pant, MA; Emanuele Di Angelantonio, MD, PhD; Oscar H. Franco, MD, PhD; and D. Prabhakaran, MD, DM, MSc to assess through randomized control trials from the developed world report whether clinical decision support systems (CDS) could provide an effective means to improve the management of hypertension (HTN). 
Can clinical decision support systems (CDS) provide an effective means to improve the management of hypertension (HTN) in third world countries?
The authors performed a cluster randomized trial to test the effectiveness and cost‐effectiveness of a CDS 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.
Findings from the studies have determined an improvement in clinical outcomes as a measure of blood pressure control and cost reduction in care.
The mean difference in SBP change from baseline between the DSS and CBS at the 12th month of follow‐up,and were adjusted for the following parameters as they were identified factors in the study which had significance:
- Body mass index (BMI)
- Alcohol consumption
- Vegetable intake
- Pickle intake
The results were the following--using CDS, 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 CDS groups was $96.01 and $36.57 per mm of SBP reduction, respectively.
CDS embedded with standardized, best-practice clinical practice guidelines aid in the management of HTN even in resource‐limited settings. CDS result in better management of HTN, provided patients adhere to the suggested dietary and lifestyle modifications, and medications and providers adhere to the suggested DSS recommendations. Key features of the DSS include the following:
- Patient-specific, tailor-made and guideline-specific recommendations for the management of HTN
- Counseling on lifestyle modification (both of when aid the clinicians and physicians in deciding the appropriate line of management for the patient.
The CDS was not only effective, but also cost‐effective in management of HTN which would be appropriate in a resource-limited area of the world.
Healthcare is a complex system where technology is becoming more prominent. However, most studies have been done in first world countries where resources are much more plentiful. This study is significant in that it demonstrates even in third-world country settings where resources are much more limited, there can be a significant impact on patient care, and demonstrate a significant savings in the financial health of the system. This proves that CDS, when well-implemented in a very thoughtful manner can be of benefit in a variety of settings. Future studies on CDS should be of a longer duration and look at assessing (1) the effectiveness of the intervention in reducing the number of MI and stroke cases (where even more cost savings can be identified) and (2) cost utility of the CDS, which, when answered, would aid in deciding the scalability and replicability of CDS in other settings and assessing whether other tools such as CPOE have a role in cost savings or patient safety in those settings.
- . Evaluation of Effectiveness and Cost‐Effectiveness of a Clinical Decision Support System in Managing Hypertension in Resource Constrained Primary Health Care Settings: Results From a Cluster Randomized Trial. J Am Heart Assoc. 2015; 4: e001213. http://jaha.ahajournals.org/content/4/1/e001213.full