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Bring hypertension guidelines into play: guideline-based decision support system for drug treatment of hypertension and epidemiological aspects of hypertension guidelines
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Umeå: Umeå Universitet , 2003. , 88 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 837
Keyword [en]
Arterial hypertension, cardiovascular risk, clinical decision support system, drug treatment, guidelines
National Category
Family Medicine
Identifiers
URN: urn:nbn:se:umu:diva-94105ISBN: 91-7305-440-2 (print)OAI: oai:DiVA.org:umu-94105DiVA: diva2:764675
Public defence
2003-05-09, Norrlands Universitetssjukhus, Byggnad 1D, 9 tr., hörsal B, Umeå universitet, Umeå, 09:00
Opponent
Supervisors
Projects
digitalisering@umu
Note

Diss. (sammanfattning) Umeå : Umeå universitet, 2003

Available from: 2014-11-20 Created: 2014-10-03 Last updated: 2015-04-10Bibliographically approved
List of papers
1. Development and maintenance of guideline-based decision support for pharmacological treatment of hypertension
Open this publication in new window or tab >>Development and maintenance of guideline-based decision support for pharmacological treatment of hypertension
2000 (English)In: Computer Methods and Programs in Biomedicine, ISSN 0169-2607, E-ISSN 1872-7565, Vol. 61, no 3, 209-219 p.Article in journal (Refereed) Published
Abstract [en]

The objective was to build a computer-based decision support system (DSS), which could apply the formal rules embedded in guidelines regarding pharmacological treatment of hypertension. The aim was also to test VISUAL BASIC as a development tool for DSS's in health care. From the Swedish guidelines for treatment of hypertension, the most widely accepted and scientifically best proved treatment strategies were chosen and implemented as rules. A DSS that is capable of applying the evidence-based rules extracted from guidelines regarding drug treatment of hypertension, to any patient's medical profile, was constructed. The output consists of a recommendation regarding preferred generic drug class and also a written report, reflecting decision steps provided by the rule-base and inference engine. We also provide methods for formalising an implementable language of guidelines. A mainstream programming language like VISUAL BASIC can be an alternative when building complicated decision support systems. A logic formal notation can facilitate communication between the expert and the programmer. The program is a stand-alone product independent of computerized medical records and thereby easy to install and maintain.

Place, publisher, year, edition, pages
Elsevier, 2000
Keyword
expert systems, guideline, hypertension, pharmacological treatment, primary health care, rule-base
National Category
Computer Science Information Systems
Identifiers
urn:nbn:se:umu:diva-21969 (URN)10.1016/S0169-2607(99)00040-1 (DOI)000085273700006 ()0169-2607 (ISBN)
Projects
digitalisering@umu
Available from: 2009-04-21 Created: 2009-04-21 Last updated: 2017-12-13Bibliographically approved
2. Evaluation of a computer-based decision support system for treatment of hypertension with drugs: retrospective, nonintervention testing of cost and guideline adherence
Open this publication in new window or tab >>Evaluation of a computer-based decision support system for treatment of hypertension with drugs: retrospective, nonintervention testing of cost and guideline adherence
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2000 (English)In: Journal of Internal Medicine, ISSN 0954-6820, E-ISSN 1365-2796, Vol. 247, no 1, 87-93 p.Article in journal (Refereed) Published
Abstract [en]

Objective. To evaluate a computerized decision support system (DSS) for drug treatment of hypertension, regarding quality, safety, and cost compared to actual antihypertensive drug treatment.

Design. The medical profiles of 338 hypertensive patients treated with drugs against hypertension were processed by the DSS. The drug treatment proposed by the system was then compared to actual treatment given by their physician.

Setting. Four health centres in the county of Västerbotten, in Sweden.

Subjects. A list of hypertensive patients was extracted from the computerized medical records of each health centre and every fifth patient’s medical profile was assessed by the system.

Interventions. None.

Main outcome measures. Drug used, drug used in relation to certain major diseases such as diabetes mellitus, asthma, ischaemic heart disease (IHD), and previous myocardial infarction. Adherence to hypertension guidelines, safety, and cost.

Results. The DSS suggested significantly more thiazides and significantly fewer calcium antagonists than the physicians had prescribed, with a total cost reduction of 33–40%, depending on doses chosen. The DSS drug profile was more adherent to guidelines in patients with major complicating diseases, suggesting an improvement in treatment quality for these patients by the DSS.

Conclusion. The DSS which fully implements current guidelines may improve the quality of antihypertensive treatment, concurrently leading to a considerable reduction in drug costs.

Place, publisher, year, edition, pages
John Wiley & Sons, 2000
Keyword
computer-assisted, cost savings, decision making, expert systems, guideline, hypertension, primary health care
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96544 (URN)10.1046/j.1365-2796.2000.00581.x (DOI)
Projects
digitalisering@umu
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-12-05Bibliographically approved
3. 1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden
Open this publication in new window or tab >>1999 WHO/ISH Guidelines applied to a 1999 MONICA sample from northern Sweden
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2002 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, 29-35 p.Article in journal (Refereed) Published
Abstract [en]

Background : Treating hypertension with drugs is so far the most cost-effective way to reduce this important risk factor for cardiovascular disease (CVD). It is, however, important to determine absolute risk, and thereby estimate indication for drug treatment, in order to maintain a cost-effective drug treatment. WHO/ISH Hypertension Guidelines from 1999 propose a risk stratification for estimating absolute risk for CVD based on blood pressure and additional risk factors, target organ damage (TOD) and CVD. Objectives : We studied the consequences of applying the recent WHO/ISH risk stratification scheme to a MONICA sample of 6000 subjects from a geographically defined population in northern Sweden, regarding indications for treatment, target blood pressure and risk distribution. Methods : We have risk-classified each of these patients using a computer program, according to the WHO/ISH scheme. Data on TOD were not available. Results : In all, 917 (15%) had drug-treated hypertension. Three-quarters (n = 737) were inadequately treated, with blood pressure levels at or above 140 or 90 mmHg. 1773 (30% of 5997) untreated subjects had a blood pressure of 140/90 or above; 16% in the low-, 62% in the medium-, 8% in the high-, and 14% in the very-high-risk group. The corresponding risk-group pattern for the inadequately treated hypertensives (n = 737) was 5.5, 48.3, 11.1 and 35.2%, respectively. If we shifted the target blood pressure from below 140/90 to below 130/85 for drug-treated subjects under 60 (n = 278) the number of inadequately treated subjects increased by 34 (12.2% of 278); 14 in the low-risk group, 15 in the medium-risk group, and only five in the high- or very-high-risk groups. Conclusions : Only one-fifth of the drug-treated hypertensives were well controlled. Moreover, the incidence of newly detected blood pressure elevation was high. The majority of younger subjects with high blood pressure had low risk, but in those aged 45-54 this had already risen to a medium risk. Changing the target blood pressure to below 130/85, for subjects aged below 60, as recommended by WHO/ISH, affects predominantly low- and medium-risk groups.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2002
Keyword
blood pressure, guidelines, hypertension, risk stratification, treatment goal
National Category
Family Medicine
Identifiers
urn:nbn:se:umu:diva-96546 (URN)
Projects
digitalisering@umu
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-12-05Bibliographically approved
4. High remaining risk in poorly treated hypertension: the "rule of halves" still exists
Open this publication in new window or tab >>High remaining risk in poorly treated hypertension: the "rule of halves" still exists
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2002 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 20, no 10, 2081-2088 p.Article in journal (Refereed) Published
Abstract [en]

To estimate risk factors for stroke, to examine how different categories of patients with increased blood pressure are associated with risk for first-ever stroke event, and to estimate the proportions of these categories in a geographically defined population in northern Sweden. Setting : The study was nested within the Vasterbotten Intervention Program and the Northern Sweden MONICA cohorts. Design and participants : A population-based cross-sectional study and an incident case-control study were carried out. The incident case-control study comprised 129 cases of first-ever stroke diagnosed during 1985-96, with two randomly selected controls per case, chosen from the same geographically defined population. The cross-sectional study was based on 59 735 participants. Blood pressure status was categorized as: normotensive [systolic blood pressure (SBP) <140 mmHg and diastolic blood pressure (DBP) <90 mmHg]; treated and adequately controlled hypertension (SBP <140 mmHg and DBP <90 mmHg); treated but poorly controlled hypertension (SBP >=140 mmHg or DBP >=90 mmHg, or both); untreated hypertension (SBP >=140 mmHg or DBP >=90 mmHg, or both); newly detected increased blood pressure (SBP >=140 mmHg or DBP >=90 mmHg, or both). Main outcome measure: Risk for first-ever stroke. Results: In the cross-sectional study, 68% of individuals were normotensive, 3% had treated and adequately controlled hypertension, 6% had treated but poorly controlled hypertension, 7% had untreated hypertension, and 16% had newly detected increased blood pressure. In univariate analysis of the case-control study, history of diabetes, daily smoking, obesity, increased blood pressure and the hypertension categories 'treated but poorly controlled' and 'untreated' were associated with an increased stroke risk. In multivariate logistic regression analysis, only diabetes and the hypertension categories treated but poorly controlled and untreated remained significant, with odds ratios 6.1 (95% confidence interval 2.4 to 15.3) and 4.3 (95% confidence interval 1.7 to 10.5), respectively. Only one of the 129 individuals who suffered stroke had treated and adequately controlled hypertension. Conclusions : The study illustrates the importance of adequate blood pressure control and, at the same time, that the vast majority in the population with increased blood pressure did not receive optimal care. Thus the 'rule of halves' still exists, and the high remaining risk in poorly treated hypertensive individuals in Sweden is remarkable and requires attention from the medical profession.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2002
Keyword
hypertension, blood pressure control, stroke, incident case referent study, primary care
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-96547 (URN)
Projects
digitalisering@umu
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-12-05Bibliographically approved
5. Risk stratification by guidelines compared to tisk assessment by risk equations applied to a MONICA sample
Open this publication in new window or tab >>Risk stratification by guidelines compared to tisk assessment by risk equations applied to a MONICA sample
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2003 (English)In: Journal of Hypertension, ISSN 0263-6352, E-ISSN 1473-5598, Vol. 21, no 6, 1089-1095 p.Article in journal (Refereed) Published
Abstract [en]

Background: The World Health Organization/International Society of Hypertension (WHO/ISH) Hypertension Guidelines from 1999 propose a risk stratification scheme for estimating absolute risk for cardiovascular disease (CVD). Risk equations estimated by statistical methods are another way of predicting cardiovascular risk. Objective: We studied the differences between these two approaches when applied to the same set of individuals with high blood pressure. Design and methods: The two northernmost counties in Sweden (NSW) constitute one of the centres in the WHO MONICA (monitoring trends and determinants in cardiovascular disease) Project. Three population surveys have been carried out in 1986, 1990 and 1994, and were used to estimate a risk equation for predicting the 10-year risk of fatal/non-fatal stroke and myocardial infarction. Another MONICA sample from 1999, a total of 5997 subjects, was classified according to the recent WHO/ISH risk stratification scheme. A risk assessment was also performed, by using the risk equations from the NSW MONICA sample and Framingham risk equations. Results: The agreement between the two methods was good when the values obtained from the risk equation were averaged for each risk group obtained from the risk classification by guidelines. However, if the predicted risk for each individual was considered, the agreement was poor for the medium and high-risk groups. Although the average risk for all individuals is the same, many subjects have a higher risk or a lower risk than predicted by guidelines. Conclusions: Risk classification by the 1999 WHO/ISH Hypertension Guidelines is not accurate and detailed enough for medium- and high-risk patients, which could be of clinical importance in the medium risk group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2003
Keyword
Hypertension Guidelines, hypertension, risk equation, risk stratification, absolute risk
National Category
Family Medicine Probability Theory and Statistics Other Mathematics
Identifiers
urn:nbn:se:umu:diva-96548 (URN)
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-12-05Bibliographically approved

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Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
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  • Other style
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Language
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  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
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  • Other locale
More languages
Output format
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