临床决策支持系统辅助社区高血压患者管理的效果研究

Impact of Clinical Decision Support System on the Management of Hypertensive Patients in Community

目的:评价社区应用心血管病危险因素管理临床决策支持系统(Clinical Decision Support System,CDSS)辅助社区高血压患者进行心血管病一级预防的管理效果。方法:入选2015年6月1日至2017年5月31日期间深圳市福田辖区76家社区健康服务中心无心脑血管病的年龄≥40岁的81 058例高血压患者,其中有4 293例使用CDSS,根据年龄进行了1:7匹配,最终纳入34 344例高血压患者,其中未使用CDSS患者30 051例为未使用CDSS组,使用CDSS患者4 293例为使用CDSS组,比较使用CDSS组和未使用CDSS组的高血压患者的高血压治疗率、达标率以及抗血小板药物和降脂药物使用情况。结果:使用CDSS组患者的每月每千人就诊次数[700(363, 1038)vs 260(31, 490),P<0.001]、每月每千人血脂检测次数[650(313, 988)vs 80(0, 181),P<0.001]和血脂异常检出率(56.80%vs 31.55%,P<0.001)均高于未使用CDSS组;使用组CDSS组的高血压治疗率(77.35%vs 67.59%,P<0.001)、血压达标率(66.99%vs 57.32%,P<0.001)、抗血小板类药物使用率(22.21%vs 13.64%,P<0.001)和他汀类药物使用率(20.62%vs 13.68%,P<0.001)也均高于未使用CDSS组。结论:CDSS能够协助社区医生管理高血压患者,可改善高血压患者的治疗率和血压达标率,也有助于提高社区高血压患者的血脂异常的检出和抗血小板药物的使用率。

Objectives:To evaluate the effect of clinical decision support system(CDSS)in the real world on the management of cardiovascular risk factors in community-based hypertensive patients.Methods:Data of 76 community health service centers in Futian district of Shenzhen city were collected from June 1,2015 to May 31,2017,including general demographic information,diagnostic information,blood pressure/lipid monitoring information,and medication information.Results:Data from a total of 81 058 hypertensive patients were collected including 4 293 CDSS patients,the proportion of men and women was 1.31:1 among CDSS patients.There were 76 765 non-CDSS patients(the ratio of male and female:1.21:1).After propensity scores for age and with a matching ratio of 1:7,this study eventually included 34 344 patients with hypertension.The number of monthly outpatient visits(700[363,1038]vs 260[31,490],P<0.001),the monthly mean number of outpatient lipids measurements(650[313,988]vs 80[0,181],P<0.001),detection rate of dyslipidemia(31.55%vs 56.80%,P<0.001),blood pressure control compliance rate(66.99%vs 57.32%,P<0.001)were all significantly higher in the CDSS patients than in non-CDSS patients.Moreover,antihypertensive drug use rate(77.35%vs 67.59%,P<0.001),antiplatelet drug use rate(22.21%vs 13.64%,P<0.001),lipid-lowering drug use rate(20.62%vs 13.68%,P<0.001)were also significantly higher in the CDSS patients than in non-CDSS patients.Conclusions:Application of the electronic clinical decision support system can help community doctors to better manage cardiovascular risk factors for hypertensive patients,effectively improve patient compliance with treatment,and improve blood pressure and blood lipid control rate in these patients.