• Med. J. Aust. · May 2021

    Randomized Controlled Trial

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

    • Ruth Webster, Tim Usherwood, Rohina Joshi, Bandana Saini, Carol Armour, Sue Critchley, Gian Luca Di Tanna, Shane Galgey, Charlotte M Hespe, Stephen Jan, Ajay Karia, Baldeep Kaur, Ines Krass, Tracey-Lea Laba, Qiang Li, Serigne Lo, David P Peiris, Christopher Reid, Anthony Rodgers, Louise Shiel, Jessica Strathdee, Nuria Zamora, and Anushka Patel.
    • Centre for Health Economics Research and Evaluation, University of Technology, Sydney, NSW.
    • Med. J. Aust. 2021 May 1; 214 (9): 420427420-427.

    ObjectivesTo 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, SettingParallel arm, cluster randomised trial in 71 Australian general practices, 5 December 2016 - 13 September 2019.ParticipantsGeneral 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.InterventionElectronic point-of-care decision support for general practices; combination cardiovascular medications (polypills); and a pharmacy-based medication adherence program.Main Outcome MeasuresProportion 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.ResultsAfter 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%).ConclusionsDespite 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.Trial RegistrationAustralian New Zealand Clinical Trials Registry, ACTRN12616000233426 (prospective).© 2021 AMPCo Pty Ltd.

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