An electronic decision support‐based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE)

Webster, R; Usherwood, T; Joshi, R; Saini, B; Armour, C; Critchley, S; Di Tanna, GL; Galgey, S; Hespe, CM; Jan, S; Karia, A; Kaur, B; Krass, I; Laba, T; Li, Q; Lo, S; Peiris, DP; Reid, C; Rodgers, A; Shiel, L; Strathdee, J; Zamora, N; Patel, A

An electronic decision support‐based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE)

Usherwood, T Joshi, R Saini, B Armour, C Critchley, S Di Tanna, GL Galgey, S Hespe, CM Jan, S Karia, A Kaur, B Krass, I Laba, T

Li, Q Lo, S Peiris, DP Reid, C Rodgers, A Shiel, L Strathdee, J Zamora, N Patel, A

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Publisher:: Australasian Medical Publishing Company
Publication Type:: Journal Article
Citation:: Medical Journal of Australia, 2021, 214, (9), pp. 420-427
Issue Date:: 2021-04-26

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Field	Value	Language
dc.contributor.author	Webster, R https://orcid.org/0000-0002-7444-3037
dc.contributor.author	Usherwood, T
dc.contributor.author	Joshi, R
dc.contributor.author	Saini, B
dc.contributor.author	Armour, C
dc.contributor.author	Critchley, S
dc.contributor.author	Di Tanna, GL
dc.contributor.author	Galgey, S
dc.contributor.author	Hespe, CM
dc.contributor.author	Jan, S
dc.contributor.author	Karia, A
dc.contributor.author	Kaur, B
dc.contributor.author	Krass, I
dc.contributor.author	Laba, T https://orcid.org/0000-0002-5182-9092
dc.contributor.author	Li, Q
dc.contributor.author	Lo, S
dc.contributor.author	Peiris, DP
dc.contributor.author	Reid, C
dc.contributor.author	Rodgers, A
dc.contributor.author	Shiel, L
dc.contributor.author	Strathdee, J
dc.contributor.author	Zamora, N
dc.contributor.author	Patel, A
dc.date.accessioned	2021-12-06T20:44:10Z
dc.date.available	2020-11-13
dc.date.available	2021-12-06T20:44:10Z
dc.date.issued	2021-04-26
dc.identifier.citation	Medical Journal of Australia, 2021, 214, (9), pp. 420-427
dc.identifier.issn	0025-729X
dc.identifier.issn	1326-5377
dc.identifier.uri	http://hdl.handle.net/10453/152161
dc.description.abstract	Objectives To determine whether a multifaceted primary health care intervention better controlled cardiovascular disease (CVD) risk factors in patients with high risk of CVD than usual care. Design, setting Parallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 – 13 September 2019. Participants General practices that predominantly used an electronic medical record system compatible with the HealthTracker electronic decision support tool, and willing to implement all components of the INTEGRATE intervention. Intervention Electronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program. Main outcome measures Proportion of patients with high CVD risk not on an optimal preventive medication regimen at baseline who had achieved both blood pressure and low-density lipoprotein (LDL) cholesterol goals at study end. Results After a median 15 months’ follow-up, primary outcome data were available for 4477 of 7165 patients in the primary outcome cohort (62%). The proportion of patients who achieved both treatment targets was similar in the intervention (423 of 2156; 19.6%) and control groups (466 of 2321; 20.1%; relative risk, 1.06; 95% CI, 0.85–1.32). Further, no statistically significant differences were found for a number of secondary outcomes, including risk factor screening, preventive medication prescribing, and risk factor levels. Use of intervention components was low; it was highest for HealthTracker, used at least once for 347 of 3236 undertreated patients with high CVD risk (10.7%). Conclusions Despite evidence for the efficacy of its individual components, the INTEGRATE intervention was not broadly implemented and did not improve CVD risk management in participating Australian general practices.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Australasian Medical Publishing Company
dc.relation	http://purl.org/au-research/grants/nhmrc/1084657
dc.relation	http://purl.org/au-research/grants/nhmrc/1125044
dc.relation.ispartof	Medical Journal of Australia
dc.relation.isbasedon	10.5694/mja2.51030
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	11 Medical and Health Sciences, 17 Psychology and Cognitive Sciences
dc.subject.classification	General & Internal Medicine
dc.subject.mesh	Humans
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Decision Support Systems, Clinical
dc.subject.mesh	Adult
dc.subject.mesh	Middle Aged
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Australia
dc.subject.mesh	Male
dc.subject.mesh	Medication Adherence
dc.subject.mesh	Electronic Health Records
dc.subject.mesh	Quality Improvement
dc.subject.mesh	Adult
dc.subject.mesh	Australia
dc.subject.mesh	Cardiovascular Diseases
dc.subject.mesh	Decision Support Systems, Clinical
dc.subject.mesh	Electronic Health Records
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Medication Adherence
dc.subject.mesh	Middle Aged
dc.subject.mesh	Point-of-Care Systems
dc.subject.mesh	Primary Health Care
dc.subject.mesh	Prospective Studies
dc.subject.mesh	Quality Improvement
dc.title	An electronic decision support‐based complex intervention to improve management of cardiovascular risk in primary health care: a cluster randomised trial (INTEGRATE)
dc.type	Journal Article
utslib.citation.volume	214
utslib.location.activity	Australia
utslib.for	11 Medical and Health Sciences
utslib.for	17 Psychology and Cognitive Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHERE - Centre for Health Economics Research and Evaluation
utslib.copyright.status	closed_access	*
pubs.consider-herdc	false
dc.date.updated	2021-12-06T20:44:08Z
pubs.issue	9
pubs.publication-status	Published
pubs.volume	214
utslib.citation.issue	9

Abstract:

Objectives To determine whether a multifaceted primary health care intervention better controlled cardiovascular disease (CVD) risk factors in patients with high risk of CVD than usual care. Design, setting Parallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 – 13 September 2019. Participants General practices that predominantly used an electronic medical record system compatible with the HealthTracker electronic decision support tool, and willing to implement all components of the INTEGRATE intervention. Intervention Electronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program. Main outcome measures Proportion of patients with high CVD risk not on an optimal preventive medication regimen at baseline who had achieved both blood pressure and low-density lipoprotein (LDL) cholesterol goals at study end. Results After a median 15 months’ follow-up, primary outcome data were available for 4477 of 7165 patients in the primary outcome cohort (62%). The proportion of patients who achieved both treatment targets was similar in the intervention (423 of 2156; 19.6%) and control groups (466 of 2321; 20.1%; relative risk, 1.06; 95% CI, 0.85–1.32). Further, no statistically significant differences were found for a number of secondary outcomes, including risk factor screening, preventive medication prescribing, and risk factor levels. Use of intervention components was low; it was highest for HealthTracker, used at least once for 347 of 3236 undertreated patients with high CVD risk (10.7%). Conclusions Despite evidence for the efficacy of its individual components, the INTEGRATE intervention was not broadly implemented and did not improve CVD risk management in participating Australian general practices.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/152161