title: Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit.
abstract: BACKGROUND
  Cardiovascular (CVD) risk management post myocardial infarction is inconsistently delivered with those who need the most receiving the least - the 'inverse care law.' The Acute PREDICT Initiative is a nurse led computerised decision support system (CDSS), to provide point-of-care guideline-based, patient-specific CVD risk management recommendations to all.
  
  
  METHODS
  All patients admitted to Middlemore Hospital CCU over 2 years with acute CVD-related events potentially 'eligible' for PREDICT assessment were identified. Age, gender, ethnicity and a small area measure of socioeconomic status (NZDep01) were assessed.
  
  
  RESULTS
  1813/2246 (81%) of people admitted were eligible for a PREDICT assessment. Of those, 973 (54%) received a complete assessment. There were no important differences by quintile of deprivation or ethnicity between the patients receiving PREDICT and the rest. PREDICT assessments were less likely for the elderly (35.7% of >75years compared with 57.7% of <75years), for women (47.1% of women and 56.5% of men), and for those who had 5 or more previous admissions.
  
  
  CONCLUSIONS
  Patients potentially at higher risk because of their ethnic or socioeconomic background received equitable access to in-hospital CVD risk management post MI using PREDICT. However, some other high-risk groups under-utilised the system.
authors.affiliation: The Department of Cardiology, Middlemore Hospital, Auckland, New Zealand. AZMcLachlan@middlemore.co.nz
authors.forename: Andy
authors.initials: A
authors.lastname: McLachlan
authors.forename: Susan
authors.initials: S
authors.lastname: Wells
authors.forename: Sue
authors.initials: S
authors.lastname: Furness
authors.forename: Rod
authors.initials: R
authors.lastname: Jackson
authors.forename: Andrew
authors.initials: A
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000451:nursing / Q000628:therapy*; D003325:Coronary Care Units / Q000458:organization & administration*; D020000:Decision Support Systems, Clinical; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D019095:Point-of-Care Systems; D012308:Risk Management / Q000458:organization & administration*; D012923:Social Class