180590 Clinician's perception of their panel's blood pressure control: Influence of ATHENA-Hypertension decision support system

Monday, October 27, 2008

Grace Yeh, MPH , Geriatrics Research Education & Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
Susana B. Martins, MD, MSc , Geriatrics Research Education & Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
Martha Michel, PhD, MS , Center for Healthcare Evaluation, VA Palo Alto Health Care System, Palo Alto, CA
Nancy D. Lin, ScD , Geriatrics Research Education & Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
Jim Bursick, MPH, MBA , Geriatrics Research Education & Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
Michael A. Steinman, MD , Medicine, San Francisco VAMC, San Francisco, CA
Michael G. Shlipak, MD, MPH , Medicine, San Francisco VAMC, San Francisco, CA
Brian Hoffman, MD , Medicine, VA Boston HCS, Boston, MA
Mary K. Goldstein, MD, MS , Geriatrics Research Education & Clinical Center, VA Palo Alto Health Care System, Palo Alto, CA
Hypertension continues to be an important public health problem in developed countries. Adequate treatment with evidence-based care is likely the most important factor in decreasing the risk for stroke and coronary heart disease. To combat hypertension, the ATHENA-Hypertension clinical decision support system at the Veterans Affairs Healthcare System encourages physicians to practice evidence-based care. At point-of-care, it provides clinicians with patient specific recommendations about blood pressure (BP) control and therapy.

To determine the impact of ATHENA-Hypertension on clinician perceptions of their panel's BP control (SBP<140 and DBP<90) reported in a survey compared with clinical data.

We conducted two clinician surveys, before and after the ATHENA-Hypertension 15-month randomized multi-site trial. Clinicians were randomly assigned to an intervention group (received ATHENA-HTN) or control group (received reminder about hypertension). 87/105 (83%) clinicians completed the pre-survey; 78/98 (80%) clinicians completed the post-survey; 52 completed both. Clinicians were asked to estimate the proportion of their hypertensive patients with controlled BP. BP data was extracted from the VA's electronic medical record system (VistA). We calculated the difference between reported BP control and actual BP control of each clinician's panel. The data was analyzed using t-tests.

There was no difference between study groups at baseline in the reported BP control and clinical data. There was a significant difference between reported and actual BP control in both study groups; clinicians greatly overestimated the proportion of patients with BP controlled. After 15 months of ATHENA-Hypertension use, clinicians reported a perception closer to clinical reality than those in the control group (p=0.02).

Clinicians overestimated the proportion of their patients with controlled BP. Use of ATHENA-Hypertension narrowed the gap between clinicians' perception of BP control and actual BP control of their patient panel. This improved awareness of BP control may increase the motivation to improve hypertension management.

Learning Objectives:
1.Identify the purpose of the ATHENA clinical decision support system and its role in encouraging evidence-based care in a primary care setting. 2.Explain how clinicians, through the use of ATHENA, can bridge the gap between current clinical practice and evidence-based recommendations for hypertension. 3.Discuss how use of the ATHENA clinical decision support tool may mitigate differences in clinicians’ awareness of blood pressure control and motivate clinicians to change prescribing patterns.

Keywords: Hypertension, Decision-Making

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the project coordinator on the ATHENA-HTN project at Veterans Affairs Hospital, Palo Alto
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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