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Stroke. 2014 Jul;45(7):2066-71. doi: 10.1161/STROKEAHA.114.005713. Epub 2014 Jun 5.

Point-of-care cluster randomized trial in stroke secondary prevention using electronic health records.

Author information

1
From the Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom (A.D., L.M., M.A., J.C., C.D.A.W., A.R., M.C.G.); NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital London, London, United Kingdom (A.D., C.D.A.W., A.R., M.C.G.); Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, United Kingdom (T.P.v.S., G.M.); London School of Hygiene & Tropical Medicine, London, United Kingdom (T.P.v.S.); and Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom (L.M., L.Y.).
2
From the Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom (A.D., L.M., M.A., J.C., C.D.A.W., A.R., M.C.G.); NIHR Biomedical Research Centre at Guy's and St Thomas' Hospital London, London, United Kingdom (A.D., C.D.A.W., A.R., M.C.G.); Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, United Kingdom (T.P.v.S., G.M.); London School of Hygiene & Tropical Medicine, London, United Kingdom (T.P.v.S.); and Division of Community Clinical Sciences, University of Southampton, Southampton, United Kingdom (L.M., L.Y.). martin.gulliford@kcl.ac.uk.

Abstract

BACKGROUND AND PURPOSE:

The aim of this study was to evaluate whether the remote introduction of electronic decision support tools into family practices improves risk factor control after first stroke. This study also aimed to develop methods to implement cluster randomized trials in stroke using electronic health records.

METHODS:

Family practices were recruited from the UK Clinical Practice Research Datalink and allocated to intervention and control trial arms by minimization. Remotely installed, electronic decision support tools promoted intensified secondary prevention for 12 months with last measure of systolic blood pressure as the primary outcome. Outcome data from electronic health records were analyzed using marginal models.

RESULTS:

There were 106 Clinical Practice Research Datalink family practices allocated (intervention, 53; control, 53), with 11 391 (control, 5516; intervention, 5875) participants with acute stroke ever diagnosed. Participants at trial practices had similar characteristics as 47,887 patients with stroke at nontrial practices. During the intervention period, blood pressure values were recorded in the electronic health records for 90% and cholesterol values for 84% of participants. After intervention, the latest mean systolic blood pressure was 131.7 (SD, 16.8) mm Hg in the control trial arm and 131.4 (16.7) mm Hg in the intervention trial arm, and adjusted mean difference was -0.56 mm Hg (95% confidence interval, -1.38 to 0.26; P=0.183). The financial cost of the trial was approximately US $22 per participant, or US $2400 per family practice allocated.

CONCLUSIONS:

Large pragmatic intervention studies may be implemented at low cost by using electronic health records. The intervention used in this trial was not found to be effective, and further research is needed to develop more effective intervention strategies.

CLINICAL TRIAL REGISTRATION URL:

http://www.controlled-trials.com. Current Controlled Trials identifier: ISRCTN35701810.

KEYWORDS:

blood pressure; cholesterol; electronic health records; intervention studies; secondary prevention; stroke

PMID:
24903985
DOI:
10.1161/STROKEAHA.114.005713
[Indexed for MEDLINE]

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