Point-of-Service reminders for prescribing cardiovascular medications.
OBJECTIVE
To provide physicians with evidence-based recommendations for care at the point of service, using an automated system, and to evaluate its effectiveness in promoting prescriptions to prevent cardiovascular events.


METHODS
Randomized controlled trial.


METHODS
Patients at risk for cardiovascular events who might benefit from angiotensin-converting enzyme inhibitors or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) were identified from electronic data in a managed care organization and randomly assigned into 2 groups. Physicians seeing outpatients in the intervention group were faxed a sheet with pertinent patient data, including a recommendation to prescribe the indicated medication. In the control group, the data sheet did not include the recommendation. Dispensed prescriptions were compared between groups.


RESULTS
More than 4000 visits were observed for each medication type. Angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers were dispensed in 7.1% of visits in the intervention group versus 5.7% in the control group (P = .048) following the first patient-physician encounter. No significant difference was observed for statins (intervention, 8.1% vs control, 7.7%). Data for all patient-physician encounters and both medications were combined in logistic regression analysis. The odds ratio was 1.19 for a dispensed prescription in the intervention group and 1.54 for 2 or more visits versus 1 visit.


CONCLUSIONS
An automated system that provides pertinent data and tailored recommendations for care at the point of service modestly increased prescription dispensing rates. Targeting patient-provider encounters to change provider behavior is challenging; however, even small effects can produce clinically important results over time.
Derose
Stephen F
SF
Southern California Kaiser Permanente Department of Research and Evaluation, 393 E Walnut Street, Pasadena, CA 91188, USA. stephen.f.derose@kp.org
Dudl
James R
JR
Benson
Victor M
VM
Contreras
Richard
R
Nakahiro
Randall K
RK
Ziel
Frederick H
FH
D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy*; D048909:Diabetes Complications; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008875:Middle Aged; D019095:Point-of-Care Systems; D017010:Reminder Systems