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Appl Clin Inform 2022; 13(05): 1131-1140
DOI: 10.1055/a-1926-0199
Research Article

Provider Perspectives on Patient- and Provider-Facing High Blood Pressure Clinical Decision Support

David A. Dorr
1   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Joshua E. Richardson
2   Center for Health Informatics and Evidence Synthesis, RTI International, Chicago, Illinois, United States
,
Michelle Bobo
1   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Christopher D'Autremont
1   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Robert Rope
3   Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States
,
MJ Dunne
1   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
,
Steven Z. Kassakian
1   Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon, United States
3   Department of Medicine, Oregon Health and Science University, Portland, Oregon, United States
,
Lipika Samal
4   Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, United States
5   Department of Medicine, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations
Funding This work was supported by the Agency for Healthcare Research and Quality (grant no.: U18 HS26849-01). The project was also supported by the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health, through grant award number of UL1TR002369.
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Abstract

Background Hypertension, persistent high blood pressures (HBP) leading to chronic physiologic changes, is a common condition that is a major predictor of heart attacks, strokes, and other conditions. Despite strong evidence, care teams and patients are inconsistently adherent to HBP guideline recommendations. Patient-facing clinical decision support (CDS) could help improve recommendation adherence but must also be acceptable to clinicians and patients.

Objective This study aimed to partly address the challenge of developing a patient-facing CDS application, we sought to understand provider variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools.

Methods We engaged hypertension experts and primary care respondents to iteratively develop and implement a pilot survey and a final survey which presented five clinical cases that queried clinicians' attitudes related to actions; variations; prioritization; patient input; importance; and barriers for HBP diagnosis, monitoring, and treatment. Analysis of Likert's scale scores was descriptive with content analysis for free-text answers.

Results Fifteen hypertension experts and 14 providers took the pilot and final version of the surveys, respectively. The majority (>80%) of providers felt the recommendations were important, yet found them difficult to follow-up to 90% of the time. Perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22 to 100%. Stated reasons for variation included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Providers were generally positive toward patient use of electronic CDS applications but worried about access to health care, nuance of recommendations, and patient understanding of the tools.

Conclusion At baseline, provider management of HBP is heterogeneous. Providers were accepting of patient-facing CDS but reported preferences for that CDS to capture the complexity and nuance of guideline recommendations.

Keywords

hypertension - decision support systems - clinical - surveys and questionnaires - practice guideline - fast healthcare interoperable resources

Protection of Human and Animal Subjects

This research was performed in compliance with current standards for human subjects research and was reviewed by the Oregon Health & Science University Institutional Review Board.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Agency for Healthcare Research and Quality.


Supplementary Material



Publication History

Received: 27 December 2021

Accepted: 11 August 2022

Accepted Manuscript online:
17 August 2022

Article published online:
30 November 2022

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