Feasibility Assessment for Implementation of Heart Failure Clinical Caremaps using Electronic Medical Records in Primary Practice
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Publié-e :
nov. 17, 2014
Mots-clés :
Electronic Medical Records, Heart Failure, Family practice/general practice/primary care
Contenu principal de l'article
Résumé
Objectives: The primary aim of this project is to evaluate the impact and level of use of Electronic Medical Records (EMRs) by family physicians (FPs) specifically with respect to HF management. This study provides pilot work towards successful implementation of HF clinical caremaps in EMRs to support decision making for FPs.
Methods: A survey questionnaire was sent to 207 FPs from which 42 (20%) replies were received. The survey included questions on demographic information of the FP's practice, specifics about HF patients and their management, EMR use and whether they have improved management in HF patients.
Results: Among the 42 FPs who responded, 39 (93%) practice in the urban area of Hamilton and each have over 10 confirmed HF patients at their family practices, supporting the need for proper management of HF at the primary care level. FPs expressed concerns about difficulty in treating HF preserved vs. systolic HF, in managing HF patients with renal insufficiency and difficulty in the use of beta blockers. There was no consensus on whether EMRs have helped in improving the management of HF patients.
Conclusions: There is a perceived need for management tools which can be integrated into EMRs to provide decision making support for FPs in managing HF. Tools such as caremaps may help provide optimal care in managing HF patients as per the Canadian Cardiovascular Society guidelines.
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Rubrique
Review & Clinical Practice
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Références
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9. Tsuyuki RT, Ackman ML, Montague TJ. Effects of the 1994 Canadian Cardiovascular Society clinical practice guidelines for congestive heart failure. Can J Cardiol 2002;18:147-52.
10. Demers C, Kaczorowski J, McKelvie R, et al. Congestive heart failure assessment and management in primary care (CHAMP-C). Canadian Journal of Cardiology, 2007; 23(SC):298c (abstract)
11. Howlett, J. G., McKelvie, R. S., Costigan, J., Ducharme, A., Estrella-Holder, E., Ezekowitz, J. A. et al. (2010). The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can.J.Cardiol., 26, 185-202.
12. Holbrook A, Thabane L, Keshavjee K, et al. Individualized electronic decision support and reminders to improve diabetes care in the com¬munity: COMPETE II randomized trial. CMAJ 2009;181(1-2):37-44.
13. Shelley D, Tseng TY, Matthews AG, et al. Technology-driven intervention to improve hypertension outcomes in community health centers. Am J Manag Care 2011;17:SP103-SP110.
14. Mishra NK, Son RY, Arnzen JJ. Towards Automatic Diabetes Case Detection and ABCS Protocol Compliance Assessment. Clin Med Res 2012.
15. Ali MK, Shah S, Tandon N. Review of electronic decision-support tools for diabetes care: a viable option for low- and middle-income countries? J Diabetes Sci Technol 2011;5:553-70.
16. Battaglia L, Aronson MD, Neeman N, Chang JD. A "smart" heart failure sheet: Using electronic medical records to guide clinical decision making. Am J Med. 2011 Feb;124(2):118-20.
17. Leslie SJ, Denvir MA. Clinical decision support software for chronic heart failure. Crit Pathw Cardiol. 2007 Sep;6(3):121-6.
18. Leslie SJ, Hartswood M, Meurig C, McKee SP, Slack R, Procter R, et al. Clinical decision support software for management of chronic heart failure: Development and evaluation. Comput Biol Med. 2006 May;36(5):495-506.
19. Toth-Pal E, Wardh I, Strender LE, Nilsson G. A guideline-based computerised decision support system (CDSS) to influence general practitioners management of chronic heart failure. Inform Prim Care. 2008;16(1):29-39.
20. Biro SC, Barber DT, Kotecha JA. Trends in the use of electronic medical records. Can Fam Physician 2012;58:e21.
21. 2010 National Physician Survey. The College of Family Physicians of Canada, Canadian Medical Association, The Royal College of Physicians and Surgeons of Canada.
22. Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, et al. A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Aff (Millwood). 2012 Dec;31(12):2805-16.
2. Howlett JG, McKelvie RS, Costigan J, et al. The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can J Cardiol 2010;26:185-202.
3. Arnold JM, Liu P, Demers C, et al. Canadian Cardiovascular Society consensus conference recommendations on heart failure 2006: diagnosis and management. Can J Cardiol 2006;22:23-45.
4. Public Health Agency of Canada. Tracking Heart Disesase and Stroke in Canada. 2009; 79-83
5. Chambers, L. W., Kaczorowski, J., Dolovich, L., Karwalajtys, T., Hall, H. L., McDonough, B. et al. (2005). A community-based program for cardiovascular health awareness. Can.J.Public Health, 96, 294-298.
6. Go AS, Rao RK, Dauterman KW, Massie BM. A systematic review of the effects of physician specialty on the treatment of coronary disease and heart failure in the united states. The American Journal of Medicine. 2000;108(3):216-226.
7. Ahmed A, Allman RM, Kiefe CI, et al. Association of consultation between generalists and cardiologists with quality and outcomes of heart failure care. Am Heart J 2003;145:1086-93.
8. Boom NK, Lee DS, Tu JV. Comparison of processes of care and clinical outcomes for patients newly hospitalized for heart failure attended by different physician specialists. Am Heart J 2012;163:252-9.
9. Tsuyuki RT, Ackman ML, Montague TJ. Effects of the 1994 Canadian Cardiovascular Society clinical practice guidelines for congestive heart failure. Can J Cardiol 2002;18:147-52.
10. Demers C, Kaczorowski J, McKelvie R, et al. Congestive heart failure assessment and management in primary care (CHAMP-C). Canadian Journal of Cardiology, 2007; 23(SC):298c (abstract)
11. Howlett, J. G., McKelvie, R. S., Costigan, J., Ducharme, A., Estrella-Holder, E., Ezekowitz, J. A. et al. (2010). The 2010 Canadian Cardiovascular Society guidelines for the diagnosis and management of heart failure update: Heart failure in ethnic minority populations, heart failure and pregnancy, disease management, and quality improvement/assurance programs. Can.J.Cardiol., 26, 185-202.
12. Holbrook A, Thabane L, Keshavjee K, et al. Individualized electronic decision support and reminders to improve diabetes care in the com¬munity: COMPETE II randomized trial. CMAJ 2009;181(1-2):37-44.
13. Shelley D, Tseng TY, Matthews AG, et al. Technology-driven intervention to improve hypertension outcomes in community health centers. Am J Manag Care 2011;17:SP103-SP110.
14. Mishra NK, Son RY, Arnzen JJ. Towards Automatic Diabetes Case Detection and ABCS Protocol Compliance Assessment. Clin Med Res 2012.
15. Ali MK, Shah S, Tandon N. Review of electronic decision-support tools for diabetes care: a viable option for low- and middle-income countries? J Diabetes Sci Technol 2011;5:553-70.
16. Battaglia L, Aronson MD, Neeman N, Chang JD. A "smart" heart failure sheet: Using electronic medical records to guide clinical decision making. Am J Med. 2011 Feb;124(2):118-20.
17. Leslie SJ, Denvir MA. Clinical decision support software for chronic heart failure. Crit Pathw Cardiol. 2007 Sep;6(3):121-6.
18. Leslie SJ, Hartswood M, Meurig C, McKee SP, Slack R, Procter R, et al. Clinical decision support software for management of chronic heart failure: Development and evaluation. Comput Biol Med. 2006 May;36(5):495-506.
19. Toth-Pal E, Wardh I, Strender LE, Nilsson G. A guideline-based computerised decision support system (CDSS) to influence general practitioners management of chronic heart failure. Inform Prim Care. 2008;16(1):29-39.
20. Biro SC, Barber DT, Kotecha JA. Trends in the use of electronic medical records. Can Fam Physician 2012;58:e21.
21. 2010 National Physician Survey. The College of Family Physicians of Canada, Canadian Medical Association, The Royal College of Physicians and Surgeons of Canada.
22. Schoen C, Osborn R, Squires D, Doty M, Rasmussen P, Pierson R, et al. A survey of primary care doctors in ten countries shows progress in use of health information technology, less in other areas. Health Aff (Millwood). 2012 Dec;31(12):2805-16.