Arch G. Mainous
A clinical decision support tool that detected potential transfusional iron overload improved management of adult patients with sickle cell disease in primary care, according to findings recently published in the Journal of the American Board of Family Medicine.
“Hematologists usually don’t have time to treat their patients with sprained ankles, or administer a pap smear, and so on and so forth. But that doesn’t mean patients with sickle cell disease don’t need these tests or have these mishaps,” Arch G. Mainous III, PhD, department chair of health services research, management and policy at the University of Florida, told Healio Family Medicine.
“Since a lot of patients with sickle cell disease are managed or co-managed in primary care, we wanted to come up with a tool that improves the management of these patients,” he added.
Researchers developed a clinical decision support tool that contained a best-practice alert and provider education in increasing the number of ferritin test orders to determine transfusional iron overload in adults with sickle cell disease. Three family medicine clinics that used the tool were matched in a 1:1 ratio with clinics that did not.
Mainous and colleagues found that when comparing primary care management in the 6 months before the clinical decision support tool’s use vs. the 6 months after, the intervention group improved patient management from 0% to 44%.
“When you put this clinical decision support tool into a primary care system, our research showed that it worked,” Mainous said in the interview. “The tool provided some extra guidance that PCPs normally wouldn’t get. It also allowed these clinicians to better manage their patient populations and not throw up their hands in frustration and pass the patient onto to a hematologist just because they don’t see patients with sickle cell disease every day.”
He added that the clinical decision support tool can likely be easily modified for other rare blood diseases. In the long term, he hopes the tool spurs a greater discussion on how electronic health records can be improved.
“PCPs know a lot about diabetes, hypertension, COPD and other common chronic conditions. We should really consider focusing clinical decision support within the EHR for conditions that are less common thereby providing true knowledge and decision support for diseases that can be managed in primary care,” Mainous told Healio Family Medicine – by Janel Miller
The authors report no relevant financial disclosures.