OBJECTIVES: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale. RESULTS: Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study. CONCLUSIONS: Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
RCT Entities:
OBJECTIVES: We sought to assess the responses of providers to recommendations generated by a computer-management system for chronic heart failure (CHF). METHODS: This study is an analysis of primary care providers' responses to evidence-based computer-generated suggestions regarding patients with CHF at one center of a randomized trial. The trial randomized primary care providers from 2 VA Medical Centers to receive care suggestions regarding patients with CHF, with or without inclusion of patient symptom data obtained from pre-visit questionnaires. At one center, providers were asked to respond to the suggestions with hand-written comments and a numerical agreement scale. RESULTS: Providers responded to 774 care suggestions (62% of the 1246 delivered). They agreed with 41%, had major disagreements with 12%, and had minor disagreements with 22%. For 7% of the care suggestions, providers asked to not see it again for that patient. The most common reasons for major or minor disagreements were a belief that the suggestion was wrong or unnecessary (45%) or would not be tolerated by the patient (32%). External barriers to implementation of guidelines, lack of guideline awareness, or disagreement with guidelines were uncommon reasons cited by providers in this study. CONCLUSIONS: Providers agreed with less than half of computer-generated care suggestions from evidence-based CHF guidelines, most often because the suggestions were felt to be inapplicable to their patients or unlikely to be tolerated.
Authors: Michael A Steinman; John B Harlow; Barry M Massie; Peter J Kaboli; Kathy Z Fung; Paul A Heidenreich Journal: J Gen Intern Med Date: 2011-05-21 Impact factor: 5.128
Authors: Sana Shoukat; Saqib A Gowani; Ather M Taqui; Rameez Ul Hassan; Zain A Bhutta; Anum I Malik; Sajjad A Sherjeel; Quratulanne Sheheryar; Sajid H Dhakam Journal: BMC Cardiovasc Disord Date: 2011-11-17 Impact factor: 2.298
Authors: Stijn Van de Velde; Ilkka Kunnamo; Pavel Roshanov; Tiina Kortteisto; Bert Aertgeerts; Per Olav Vandvik; Signe Flottorp Journal: Implement Sci Date: 2018-06-25 Impact factor: 7.327