Abstract
BackgroundThe EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. There is no clear evidence of more complex CCDS systems to manage chronic diseases in primary care practices (PCPs). The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care.MethodsA cluster-randomized trial with before-and-after measurements was performed in Belgian PCPs over 1 year, from May 2017 to May 2018. We randomly assigned 51 practices to either the intervention group (IG), to receive the EBMeDS system, or to the control group (CG), to receive usual care. Primary and secondary outcomes were the 1-year pre- to post-implementation change in HbA1c, LDL cholesterol, and systolic and diastolic blood pressure. Composite patient and process scores were calculated. A process evaluation was added to the analysis. Results were analyzed at 6 and 12 months. Linear mixed models and logistic regression models based on generalized estimating equations were used where appropriate.ResultsOf the 51 PCPs that were enrolled and randomly assigned (26 PCPs in the CG and 25 in the IG), 29 practices (3815 patients) were analyzed in the study: 2464 patients in the CG and 1351 patients in the IG. No change differences existed between groups in primary or secondary outcomes. Change difference between CG and IG after 1-year follow-up was − 0.09 (95% CI − 0.18; 0.01, p-value = 0.06) for HbA1c; 1.76 (95% CI − 0.46; 3.98, p-value = 0.12) for LDL cholesterol; and 0.13 (95% CI − 0.91; 1.16, p-value = 0.81) and 0.12 (95% CI − 1.25;1.49, p-value = 0.86) for systolic and diastolic blood pressure respectively. The odds ratio of the IG versus the CG for the probability of no worsening and improvement was 1.09 (95% CI 0.73; 1.63, p-value = 0.67) for the process composite score and 0.74 (95% CI 0.49; 1.12, p-value = 0.16) for the composite patient score. All but one physician was satisfied with the EBMeDS system.ConclusionsThe CCDS system EBMeDS did not improve diabetes care in Belgian primary care. The lack of improvement was mainly caused by imperfections in the organizational context of Belgian primary care for chronic disease management and shortcomings in the system requirements for the correct use of the EBMeDS system (e.g., complete structured records). These shortcomings probably caused low-use rates of the system.Trial registrationClinicalTrials.gov, NCT01830569, Registered 12 April 2013.
Highlights
Evidence is of no use if it remains buried in the literature and is not implemented in practice
A number of studies have already shown positive findings for some types of decision support systems such as drug-dosing systems and computer-based reminder systems for preventive care services [3,4,5,6,7]. These clinical decision support (CCDS) systems are important in chronic disease management such as the management of diabetes, which was chosen as the analysis topic of interest in this study
Analysis was performed using the intention-to-treat principle, but patients in practices who stopped using the EBMeDS system could no longer be analyzed because these practices stopped their participation in the trial
Summary
Background and rationale Evidence is of no use if it remains buried in the literature and is not implemented in practice. A number of studies have already shown positive findings for some types of decision support systems such as drug-dosing systems and computer-based reminder systems for preventive care services [3,4,5,6,7]. These CCDS systems are important in chronic disease management such as the management of diabetes, which was chosen as the analysis topic of interest in this study. The EBMeDS system is the computerized clinical decision support (CCDS) system of EBPNet, a national computerized point-of-care information service in Belgium. The objective of this study was to assess the effectiveness of EBMeDS use in improving diabetes care
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