Electronic health records, clinical decision support mitigate BP control disparities
MedWire News: US researchers say that primary care implementation of electronic health records (EHRs) with clinical decision support (CDS) could mitigate blood pressure (BP) control disparities between White and Black patients.
This in turn may reduce racial disparities in morbidity and mortality from cardiovascular disease, write Lipika Samal (Brigham and Women's Hospital, Boston, Massachusetts) and co-authors in the Archives of Internal Medicine.
They examined data from 17,016 primary care visits in the 2007-2008 National Ambulatory Medical Care Survey, a nationally representative sample of 682 million hospital-based ambulatory visits. Patients had a mean age of 51 years, 33% were men, 15% had diabetes, and 34% had hypertension.
Overall, 64% of the patients were non-Hispanic White, 14% were non-Hispanic Black, and 15% were Hispanic.
The findings revealed that after controlling for patient characteristics and practice ownership, 71% of non-Hispanic Black patients had controlled BP (<140/90 mmHg) compared with 76% of both Hispanic and non-Hispanic White patients (p<0.001).
Overall, 15% of visits were made to physicians using only EHRs, 27% to physicians using both EHRs and CDS, and 48% to physicians using neither. Fully adjusted analyses demonstrated improved BP control for all racial groups among patients receiving care from health providers using EHRs and CDS.
Indeed, 85% of Hispanic patients receiving care from health providers using EHRs and CDS achieved BP control (p<0.001), compared with 76% of those receiving care from physicians using EHR only, and 72% of those receiving care from physicians using neither (p<0.001). Similar associations were seen for White and Black patients, although the association between EHR-only care and BP control was nonsignificant.
Hispanic patients were significantly more likely to have controlled BP, at 85%, than were non-Hispanic White patients, at 78% (p=0.001).
"We found that previously documented patterns of racial/ethnic disparities are present among patients whose physicians are not using EHRs or CDS," write the authors.
They add that because of the study's cross-sectional design, it was not possible to ascertain how the combination of EHRs and CDS decreases disparities.
"Prospective trials must be conducted to answer these important questions," Samal and team conclude.
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By Piriya Mahendra