Use of IndiGO individualized clinical guidelines in primary care.

{"article_title":"Use of IndiGO individualized clinical guidelines in primary care.","author":"Bellows J, Patel S, Young SS","journal_title":"Journal of the American Medical Informatics Association : JAMIA","issn":"1527-974X","isbn":"","publication_date":"2014 May-Jun","volume":"21","issue":"3","first_page":"432","page_count":"","accession_number":"24029599","doi":"10.1136\/amiajnl-2012-001595","publisher":"Oxford University Press","doctype":"Comparative Study","subjects":"Antihypertensive Agents therapeutic use; Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use; Myocardial Infarction prevention & control; Patient Care Management standards; Practice Guidelines as Topic; Primary Health Care methods; Stroke prevention & control; Adult; Case-Control Studies; Electronic Health Records; Female; Humans; Male; Middle Aged; Models, Theoretical; Quality Improvement; Risk Factors","interest_area":["Internal\/Family Medicine"],"abstract":"Objective: To determine if IndiGO individualized clinical guidelines could be implemented in routine practice and assess their effects on care and care experience. Methods: Matched comparison observational design. IndiGO individualized guidelines, based on a biomathematical simulation model, were used in shared decision-making. Physicians and patients viewed risk estimates and tailored recommendations in a dynamic user interface and discussed them for 5-10 min. Outcome measures were prescribing and dispensing of IndiGO-recommended medications, changes in physiological markers and predicted 5-year risk of heart attack and stroke, and physician and patient perceptions. Results: 489 patients using IndiGO were 4.9 times more likely to receive a statin prescription than were matched usual care controls (p=0.015). No effect was observed on prescribing of antihypertensive medications, but IndiGO-using patients were more likely to pick up at least one dispensing (p<0.05). No significant changes were observed in blood pressure or serum lipid levels. Predicted risk of heart attack or stroke decreased 1.6% among patients using IndiGO versus 1.0% among matched controls (p<0.01). Physician and patient experiences were positive to neutral. Limitations: We could not assess the separate effects of individualized guidelines, user interface, and physician-patient discussions. Patient selection could have influenced results. The measure of risk reduction was not independent of the individualized guidelines. Conclusions: IndiGO individualized clinical guidelines were successfully implemented in primary care and were associated with increases in the use of cardioprotective medications and reduction in the predicted risk of adverse events, suggesting that a larger trial could be warranted.","url":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=mdl&AN=24029599&authtype=shib&custid=ns346513","isPdfLink":true,"isSAML":false,"additionalInfo":{"Authored_By":"Bellows J, Patel S, Young SS","Journal_Info":"Publisher: Oxford University Press Country of Publication: England NLM ID: 9430800 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-974X (Electronic) Linking ISSN: 10675027 NLM ISO Abbreviation: J Am Med Inform Assoc Subsets: MEDLINE","Publication_Type":"Comparative Study; Journal Article; Observational Study","Published_Date":"2014-05-01","Source":"Journal of the American Medical Informatics Association : JAMIA [J Am Med Inform Assoc] 2014 May-Jun; Vol. 21 (3), pp. 432-7. Date of Electronic Publication: 2013 Sep 12.","Languages":"English","Electronic_ISSN":"1527-974X","MeSH_Terms":"Practice Guidelines as Topic*, Antihypertensive Agents\/*therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors\/*therapeutic use , Myocardial Infarction\/*prevention & control , Patient Care Management\/*standards , Primary Health Care\/*methods , Stroke\/*prevention & control, Adult ; Case-Control Studies ; Electronic Health Records ; Female ; Humans ; Male ; Middle Aged ; Models, Theoretical ; Quality Improvement ; Risk Factors","Subjects":"Adult, Case-Control Studies, Electronic Health Records, Female, Humans, Male, Middle Aged, Models, Theoretical, Quality Improvement, Risk Factors, Antihypertensive Agents therapeutic use, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Myocardial Infarction prevention & control, Patient Care Management standards, Practice Guidelines as Topic, Primary Health Care methods, Stroke prevention & control","Title_Abbreviations":"Journal of the American Medical Informatics Association : JAMIA","Volume":"21"},"header":{"DbId":"mdl","DbLabel":"MEDLINE Ultimate","An":"24029599","RelevancyScore":"777","PubType":"Academic Journal","PubTypeId":"academicJournal","PreciseRelevancyScore":"777.392272949219"},"plink":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=24029599&authtype=shib&custid=ns346513&group=main&profile=eds","upload_link":"https:\/\/search.ebscohost.com\/login.aspx?direct=true&site=eds-live&db=mdl&AN=24029599&authtype=shib&custid=ns346513&group=main&profile=eds"}