Adherence to a guideline on cardiovascular prevention: A comparison between general practitioners and practice nurses

Voogdt-Pruis, Helene R.; Ree, J.W. van; Gorgels, Anton P.M.; Beusmans, George

doi:10.1016/j.ijnurstu.2010.11.008

Cited by 32 publications

(23 citation statements)

References 52 publications

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“…Nurse practitioners have been reported to be more likely to follow guidelines and document care [37, 38]. In addition, NPs may be more likely to accept CDSS recommendations about drugs as a result of having less pharmacology training than physicians [39].…”

Section: Discussionmentioning

confidence: 99%

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system

Ancker

Edwards

Nosal

et al. 2017

BMC Med Inform Decis Mak

417

291

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BackgroundAlthough alert fatigue is blamed for high override rates in contemporary clinical decision support systems, the concept of alert fatigue is poorly defined. We tested hypotheses arising from two possible alert fatigue mechanisms: (A) cognitive overload associated with amount of work, complexity of work, and effort distinguishing informative from uninformative alerts, and (B) desensitization from repeated exposure to the same alert over time.MethodsRetrospective cohort study using electronic health record data (both drug alerts and clinical practice reminders) from January 2010 through June 2013 from 112 ambulatory primary care clinicians. The cognitive overload hypotheses were that alert acceptance would be lower with higher workload (number of encounters, number of patients), higher work complexity (patient comorbidity, alerts per encounter), and more alerts low in informational value (repeated alerts for the same patient in the same year). The desensitization hypothesis was that, for newly deployed alerts, acceptance rates would decline after an initial peak.ResultsOn average, one-quarter of drug alerts received by a primary care clinician, and one-third of clinical reminders, were repeats for the same patient within the same year. Alert acceptance was associated with work complexity and repeated alerts, but not with the amount of work. Likelihood of reminder acceptance dropped by 30% for each additional reminder received per encounter, and by 10% for each five percentage point increase in proportion of repeated reminders. The newly deployed reminders did not show a pattern of declining response rates over time, which would have been consistent with desensitization. Interestingly, nurse practitioners were 4 times as likely to accept drug alerts as physicians.ConclusionsClinicians became less likely to accept alerts as they received more of them, particularly more repeated alerts. There was no evidence of an effect of workload per se, or of desensitization over time for a newly deployed alert. Reducing within-patient repeats may be a promising target for reducing alert overrides and alert fatigue.

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Section: Discussionmentioning

confidence: 99%

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system

Ancker

Edwards

Nosal

et al. 2017

BMC Med Inform Decis Mak

417

291

View full text Add to dashboard Cite

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“…At least one other study found that NPs are more likely to be compliant with practice guidelines. 6 This study has prompted us to analyze the compliance with our guidelines based on the location of the patient. The influence of the attending physician or fellow supervising the trauma teams is interesting.…”

Section: Discussionmentioning

confidence: 99%

The influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma

Morris

Reilly

Rohrbach

et al. 2012

Journal of Trauma and Acute Care Surgery

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“…Nurse-coordinated programmes are associated with modest but positive effects on reducing cholesterol levels according to recent meta-analyses 6 16. However, studies assessing patients’ medication adherence found improved patient adherence in one study17 and no differences between NCC and usual care in two other studies 18 19. Reasons for poor patient adherence are multifactorial.…”

Section: Discussionmentioning

confidence: 94%

Nurse-coordinated care improves the achievement of LDL cholesterol targets through more intensive medication titration

et al. 2017

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BackgroundNurse-coordinated care (NCC) improves the achievement of low-density lipoprotein-cholesterol (LDL-C) targets after an acute coronary syndrome (ACS). We hypothesised that NCC improves achievement of LDL-C targets through more intensive medication titration.MethodsWe used data from Randomised Evaluation of Secondary Prevention by Outpatient Nurse Specialists (RESPONSE), a multicentre randomised trial on the efficacy of NCC in 754 ACS patients. Follow-up data were collected at 6 and 12 months. To enable comparison between the various types and dosages of statins, we used the average lipid-lowering potency (ALLP, % LDL-C lowering) as an indicator of lipid-lowering medication intensity.ResultsMost patients in NCC intervention and usual care groups (96%) had started lipid-lowering therapy during the index hospitalisation. At 6 months, titration activities (up or down) were applied in 45% of NCC patients compared with 24% of patients receiving usual care (p<0.001), and a difference was also seen at 12 months follow-up (52% vs 34%, p<0.001). In patients not on LDL-C target at baseline, titration activities at 6 months were recorded in 63% and 30% of NCC and usual care patients respectively (p<0.001), with increased titration activities in both groups at 12 months (69% vs 43%, p<0.001).ConclusionNCC is associated with more frequent and intense lipid-lowering medication titration to reach LDL-C targets as compared with usual care alone. Further, merely starting the guideline-recommended dose is insufficient to reach the guideline-recommended LDL-C target level.Trial Registration numberTC1290 (Netherlands).

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Adherence to a guideline on cardiovascular prevention: A comparison between general practitioners and practice nurses

Cited by 32 publications

References 52 publications

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system

Effects of workload, work complexity, and repeated alerts on alert fatigue in a clinical decision support system

The influence of unit-based nurse practitioners on hospital outcomes and readmission rates for patients with trauma

Nurse-coordinated care improves the achievement of LDL cholesterol targets through more intensive medication titration

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