A new clinical decision support-based tool can help primary care physicians improve the care and management of patients with sickle cell disease (SCD), a study reports.
The study, “Effectiveness of Clinical Decision Support Based Intervention in the Improvement of Care for Adult Sickle Cell Disease Patients in Primary Care,” was published in the Journal of the American Board of Family Medicine.
However, there are complications associated with repeated transfusions, including iron overload, which can have a negative impact on a patient’s quality of life. Iron levels should be continuously monitored over the course of the disease.
These complexities of care, as well as medication improvements and complications associated with treatment, may be overlooked in a primary care setting where the health provider may not have sufficient information or the necessary tools to provide high-quality care.
“Primary care physicians need to be provided appropriate and up-to-date recommendations in a timely fashion, possibly through decision support at the point of care. Family physicians believe that clinical decision support (CDS) may help them in managing SCD complications,” the study authors wrote.
These researchers evaluated the effectiveness of providing primary care physicians with the necessary tools and information to help them promptly assess iron levels in SCD patients with a history of blood transfusions.
A clinical decision support-based intervention tool was implemented in the electronic health record system for three family medicine clinics at the University of Florida.
This tool educated the faculty and clinic staff about the complications of iron overload in SCD patients receiving blood transfusions.
It also incorporated a “best-practice alert” that informed the physician of the patient’s last blood transfusion date and prompted him or her to schedule a ferritin test to determine iron levels in those patients. Results from the patient’s five most recent ferritin tests were also displayed to help the physician make an informed decision about the test.
As a control group, the researchers also monitored three general internal medicine clinics at the University of Florida that did not receive the tool.
The team collected data for the six months before and after the introduction of the tool to evaluate any improvement in patient care and the number of ferritin tests ordered.
The total number of adult SCD patients seen during the study were 47 at the family medicine clinics and 24 at the general internal medicine clinics. All patients were at least 18 years old.
Before implementing the clinical decision support tool, there was no significant difference between the two groups regarding the number of ferritin test orders. No ferritin tests (0%) were ordered for any of the patients in either the family medicine or general internal medicine clinics.
During the six months after the introduction of the clinical decision support tool, the proportion of SCD patients in the family medicine clinics for whom their primary care provider ordered a ferritin test increased to 44% (11 orders for 25 patients). The general internal medicine group, however, did not see any such increase during this period with no patients receiving a test order.
The marked increase in the tests observed in the family medicine group could be attributed to the best practice alert that appeared 379 times during this six-month period.
“The American Board of Family Medicine and Department Chairs in Family Medicine encourage a broad scope of care for family physicians, and these results point to the viability of managing patients with rare diseases when assistance is provided,” the researchers wrote.
The clinical decision support tool currently only provides a check for transfusion iron overload, but as a next step, the researchers plan to incorporate management of iron overload with chelation therapy (used to remove excess iron from the body) in the tool.
“Future research will focus on enhancing the current decision support system and evaluating its adoption and effectiveness for both process outcomes as well as patient outcomes,” they concluded.
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