Medication Management and Culture of Safety (MM)

University of Colorado Denver (CU Denver)

Status: Completed

Conditions: Cardiovascular Disease

Treatments: Behavioral: EHR prompt and patient prompt; Behavioral: Electronic Health Record (EHR) prompt; Behavioral: academic detailing

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT01247454

09-0481

R18HS017886 (U.S. AHRQ Grant/Contract)

Details and patient eligibility

About

There will be no significant decrease in the use of low dose acetylsalicylic acid (ASA) therapy for primary prevention across the three intervention arms from baseline to completion of the project.

There will be no significant differences in the percentage of patients with diabetes mellitus greater than 44 years of age on low dose ASA therapy for primary prevention across the three arms of the study using repeated measures from baseline to completion of the project.

Full description

We will assess the current use of aspirin therapy for primary and secondary cardiovascular disease prevention in six general internal medicine and family medicine clinics within the University of Colorado Hospital system using electronic health record data.

We will develop messages concerning the appropriate use of aspirin for cardiovascular disease prevention for academic detailing to clinicians, a point of care (EHR) decision support aid for clinicians, and a short information sheet (generated by a CDS) for patients.

We will test the effectiveness of interventions to improve the evidence-based use of aspirin for primary and secondary prevention of cardiovascular disease using a randomized trial in the six University of Colorado Hospital primary care practices studied. The three intervention arms will include:

1.academic detailing and cessation of the primary prevention reminder within the point of care clinical decision support system (EHR/CDS) only 2. academic detailing with an EHR/CDS message asking clinicians to consider stopping aspirin therapy for primary prevention embedded in the point of care clinical decision support system 3. academic detailing with the EHR/CDS point of care message for clinicians in the second paragraph above, and a short information sheet to be given to patients prior to a visit to ask them to check with their provider concerning their use of aspirin for primary prevention

Enrollment: 7,000 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• All patient on low-dose aspirin without an appropriate diagnosis of coronary artery disease or thrombotic stroke/transient ischemic attack (TIA) within the six practices.

Exclusion criteria

• Persons not on aspirin therapy or persons on aspirin therapy for reasons other than prevention of cardiovascular disease (i.e., pain relief) will not be included in the study.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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7,000 participants in 3 patient groups

academic detailing

Other group

Description:

All arms will receive this intervention

Treatment:

Behavioral: academic detailing

Electronic Health Record (EHR) prompt

Experimental group

Description:

One intervention arm will receive the EHR prompt along with the academic detailing

Treatment:

Behavioral: Electronic Health Record (EHR) prompt

EHR prompt and patient prompt

Experimental group

Description:

The final arm will receive this combined intervention plus the academic detailing

Treatment:

Behavioral: EHR prompt and patient prompt