TY - JOUR AU - Peiris, David P AU - Joshi, Rohina AU - Webster, Ruth J AU - groenesstein, Patrick AU - Usherwood, Tim P AU - Heeley, Emma AU - Turnbull, Fiona M AU - Lipman, Alexandra AU - Patel, Anushka A PY - 2009 DA - 2009/12/17 TI -辅助初级保健提供者心血管疾病风险管理的电子临床决策支持工具:发展和混合方法评价KW -决策支持系统KW -临床KW -心血管疾病KW -医生，家庭KW -原住民，澳大利亚AB -背景:将心血管疾病(CVD)风险管理的成熟证据转化为临床实践仍然存在挑战。虽然电子临床决策支持(CDS)系统被认为可以提高从业者的表现，但它们在澳大利亚初级卫生保健机构的发展是有限的。目的:研究的目的是:(1)开发一个有效的CDS工具，帮助澳大利亚全科医生(gp)进行全球心血管疾病风险管理;(2)初步评估其作为全科医生的可接受性，作为普通人群和服务不足人群的护理点资源。方法:将心血管疾病风险评估(基于Framingham算法)和基于风险的管理建议(使用六项澳大利亚指南的建议)编入软件包。工具验证:分析了137名参加医生诊所的患者的数据，将工具的风险评分与单独统计包中独立编程算法获得的风险评分进行比较。该工具的管理建议与医生基于手动审查指南的建议进行比较。实地测试:随后，来自8个全科诊所和3个土著医疗服务机构的21名全科医生对该工具进行了测试。使用研究助理从健康记录中提取的信息，为200名常规就诊患者(33%土著居民)生成了基于cd的定制建议。全科医生在每次会诊期间都审查了这些建议。 Changes in CVD risk factor measurement and management were recorded. In-depth interviews with GPs were conducted. Results: Validation testing: The tool’s risk assessment algorithm correlated very highly with the independently programmed version in the separate statistics package (intraclass correlation coefficient 0.999). For management advice, there were only two cases of disagreement between the tool and the physician. Field test: GPs found 77% (153/200) of patient outputs easy to understand and agreed with screening and prescribing recommendations in 72% and 64% of outputs, respectively; 26% of patients had their CVD risk factor history updated; 73% had at least one CVD risk factor measured or tests ordered. For people assessed at high CVD risk (n = 82), 10% and 9%, respectively, had lipid-lowering and BP-lowering medications commenced or dose adjustments made, while 7% newly commenced anti-platelet medications. Three key qualitative findings emerged: (1) GPs found the tool enabled a systematic approach to care; (2) the tool greatly influenced CVD risk communication; (3) successful implementation into routine care would require integration with practice software, minimal data entry, regular revision with updated guidelines, and a self-auditing feature. There were no substantive differences in study findings for Aboriginal Medical Services GPs, and the tool was generally considered appropriate for use with Aboriginal patients. Conclusion: A fully-integrated, self-populating, and potentially Internet-based CDS tool could contribute to improved global CVD risk management in Australian primary health care. The findings from this study will inform a large-scale trial intervention. SN - 1438-8871 UR - //www.mybigtv.com/2009/4/e51/ UR - https://doi.org/10.2196/jmir.1258 UR - http://www.ncbi.nlm.nih.gov/pubmed/20018588 DO - 10.2196/jmir.1258 ID - info:doi/10.2196/jmir.1258 ER -