BACKGROUND: Hypertension persistently high blood pressures (HBP) leading to chronic physiologic changes, is a common condition that is a major predictor of heart attacks, strokes, and other conditions. Despite strong evidence, care teams inconsistently follow HBP guideline recommendations. Patient-facing clinical decision support (CDS) could help improve recommendation adherence, but must also be acceptable to clinicians.
OBJECTIVE: To partly address the challenge of developing a patient-facing CDS application, we sought to understand care team variations and rationales related to HBP guideline recommendations and perceptions regarding patient role and use of digital tools.
METHODS: We engaged HBP experts and primary care providers to iteratively develop and implement a pilot survey and a final survey, which presented five clinical cases that queried clinicians' attitudes related to actions, variations, prioritization, patient input, importance, and barriers for HBP diagnosis, monitoring, and treatment. Analysis of Likert scale scores was descriptive with content analysis for free-text answers.
RESULTS: Fifteen clinician experts and 14 providers took the pilot and final version of the surveys, respectively. The majority (>80%) of providers felt the recommendations were important, yet found them difficult to follow up to 90% of the time. Perceptions of relative amounts of patient input and patient work for effective HBP management ranged from 22-100%. Stated reasons for variation included adverse effects of treatment, patient comorbidities, shared decision-making, and health care cost and access issues. Providers were generally positive toward patient use of electronic CDS applications, but worried about access to health care, nuance of recommendations, and patient understanding of the tools.
DISCUSSION: At baseline, provider management of HBP is heterogeneous. Clinicians were accepting of patient-facing CDS but reported preferences for that CDS to capture the complexity and nuance of guideline recommendations.