EHR-based intervention for secondary stroke prevention flops

The low adoption rate of an EHR-based intervention to prevent secondary stroke likely doomed its effectiveness, based on results published online June 5 in Stroke.

Researchers in the United Kingdom attempted to provide family practice clinicians with tools that drew from EHRs to assist in clinical decision making. However, out of 53 interventional practices, half of participating clinics accessed it less than eight times over the course of the 12-month study; a quarter of clinics in the intervention didn’t access the tools at all.

Lead author Alex Dregan, PhD, of the NIHR Biomedical Research Center at Guy’s and St. Thomas’s Hospital and the Department of Primary Care and Public Health Sciences at King’s College London, and colleagues wrote, “The low utilization and lack of effectiveness of the trial intervention indicate that more research must be done to develop effective intervention strategies before this approach to delivering cluster trials can be considered entirely successful.”

As a result, patients of interventional clinics had close to the same average blood pressure (131.4/74.7 mm Hg vs 131.7/74.5 mm Hg) and cholesterol (4.35 vs 4.35 mmol/L) numbers as seen in the control group.

“The substantive results of the trial showed that the intervention was not associated with changes in BP, total cholesterol, and drug use,” Dregan et al wrote. “[T]his emphasizes the importance of developing more effective behavior change interventions that can be delivered remotely to health professionals.”

Had the intervention been successful, Dregan et al estimated the implementation cost of the trial to be as low as $22 per patient. These findings are not promising for many other similar concepts currently being tested; however, they revealed the importance of getting clinician enthusiasm and participation early in successfully testing and utilizing EHR-based tools to achieve their best effect.