Equity of access to CVD risk management using electronic clinical decision support in the coronary care unit.
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.
McLachlan
Andy
A
The Department of Cardiology, Middlemore Hospital, Auckland, New Zealand. AZMcLachlan@middlemore.co.nz
Wells
Susan
S
Furness
Sue
S
Jackson
Rod
R
Kerr
Andrew
A
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