Cardiovascular disease (CVD) remains a leading cause of death globally. Translating evidence-based guidelines into consistent clinical practice can be challenging for primary care physicians. This study details the development and preliminary evaluation of a clinical decision support (CDS) tool designed to assist Australian general practitioners (GPs) in comprehensive CVD risk management.
This CDS tool incorporates Framingham risk algorithms and management recommendations from six Australian guidelines into a user-friendly software package. The tool’s accuracy was rigorously validated against an independently programmed algorithm, demonstrating near-perfect correlation (intraclass correlation coefficient 0.999). Furthermore, the tool’s management recommendations aligned with expert physician review in nearly all cases, with only two instances of disagreement.
Following validation, the tool underwent field testing with 21 GPs across diverse practice settings, including Aboriginal Medical Services. Customized recommendations were generated for 200 patients, and GPs reviewed these during routine consultations. The majority of GPs (77%) found the patient outputs easy to understand and agreed with the screening (72%) and prescribing (64%) recommendations. The tool prompted updates to CVD risk factor history for 26% of patients and initiated measurement or testing of at least one risk factor in 73% of patients.
Among high-risk individuals (n=82), the tool facilitated medication adjustments: 10% commenced or adjusted lipid-lowering medications, 9% had blood pressure medication changes, and 7% started anti-platelet therapy. Qualitative feedback revealed that the tool promoted a systematic approach to care, significantly impacted CVD risk communication, and highlighted key requirements for successful implementation. These include seamless integration with existing practice software, minimized data entry, regular updates reflecting current guidelines, and a self-auditing functionality.
Importantly, the study found no significant differences in findings between general practices and Aboriginal Medical Services, suggesting the tool’s applicability across diverse patient populations. GPs generally considered the tool suitable for use with Aboriginal patients.
This research demonstrates the potential of a well-designed Primary Care Physician Decision Support Tool to improve CVD risk management. A fully integrated, self-populating, and potentially internet-based CDS system, as envisioned based on these findings, could significantly enhance CVD care in Australian primary health care settings. This study’s results will inform a larger-scale trial to further evaluate the tool’s impact. Future research will focus on optimizing implementation strategies and assessing long-term clinical outcomes.
