Protocol care for hypertension supported by an expert system.
1. PURPOSE. Hypertension if one of the major prevalent diseases that influences the prognosis of chronic diseases. Primary care should attract much attention in the management of hypertension. The management of hypertension includes not only the use of antihypertensiove drugs, but also the modification of unhealthy lifestyles. Multi-dimensional approaches are required for the management of hypertensive patients. This system supports the standard protocol care for hypertensive patients and the database for clinical epidemiology. 2. DESIGN CONSIDERATIONS. This system has several functions that support the appropriate management of hypertensive patients. The first one is clinical database management. The second is the evaluation of the clinical conditions in hypertension. The third is the decision support system for the selection of treatments for hypertension. 3. SYSTEM DESCRIPTION. This system administers the clinical database, which includes symptoms and signs, laboratory data, and prescriptions. The database deals with the temporal course of the patient's status. The system that evaluates the patient's condition and the decision support system have some knowledge bases. The knowledge bases consist of the evaluation of the patient's condition, the appropriate selection of laboratory examinations, and suggestions for treatments, which involve a life-style modification and the proper prescription of medication. 4. STATUS REPORTS. The relational database was developed for handling the patient's records. These records were displayed on the terminal according to the temporal sequence. The graphical representations of the medical data were displayed in order to understand the patient's status. 5. LESSON LEARNED. This kind of protocol care system is expected to support the proper medical care of patients. Excess medications and laboratory examinations will be excluded under the protocol care, thus reducing unnecessary medical expense. The system will enhance the randomized clinical trials that verify the effects of the treatments. Violation of the protocol care is treated according to the several levels. 6. FUTURE PLANS. This system will be introduced to the occupational health care fields. The efficacy of improving the clinical quantity, and the effect of reducing the medical budget concerning hypertension will be verified.
Takahashi
E
E
Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Shinjuku, Tokyo 160, Japan.
Yoshida
K
K
Izuno
T
T
Miyakawa
M
M
Sugimori
H
H
D002985:Clinical Protocols; D003196:Computer Graphics; D005103:Expert Systems; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D016347:Medical Records Systems, Computerized; D013813:Therapy, Computer-Assisted