Date Published: August 24, 2010
Publisher: Public Library of Science
Author(s): Sue Wells, Robyn Whittaker, Enid Dorey, Chris Bullen
Abstract: Robyn Whittaker and colleagues argue that IT-based programs can improve cardiovascular disease management and patient empowerment, but must be accompanied by supportive social and political environments and active patient and clinician engagement.
Partial Text: Cardiovascular disease (CVD) is one of the leading causes of death and disability worldwide, accounting for 16.7 million (29.2%) of total global deaths, 80% of them taking place in low- or middle-income countries . While death is inevitable, premature death and loss of productive years of life from CVD is, for the most part, preventable. Much can be achieved by population-wide interventions that seek to lower cigarette and salt consumption, obesity prevalence, and blood cholesterol levels in the entire population . At a personal health level, there is an abundance of evidence that reducing modifiable CVD risk factors (smoking, lipid fractions, blood pressure, diabetes) through drug, dietary, and other interventions can prevent or delay CVD events. Almost all adults could achieve a 50%–80% relative reduction in CVD risk if they took a combination of a lipid-lowering drug, a blood pressure lowering drug, and aspirin . The higher the pre-treatment CVD risk, the greater the absolute benefit and therefore the greater the cost-effectiveness of treatment . Therefore, many national guidelines now advocate identifying those at high risk of a future CVD event in the short-term and tailoring the intensity of management for individuals according to their baseline CVD risk.
Large gaps have been demonstrated between what is known to be effective and what is actually done in health care ,. Studies have shown that a formal CVD risk assessment to systematically identify high-risk patients is rarely conducted ,, and audits of care indicate substantial under-use of effective CVD interventions by clinicians –.
There is growing interest in the potential of information technology (IT) to reduce human error and variation in patient care. A recent systematic review has investigated the impact of a wide range of health IT . Three major benefits were found for quality of care (particularly in association with preventive care):
The benefits of implementing a systematic health IT approach could include improvements in the quality of care, reduced duplication, improving access to services in areas of growing demand and limited resources, and improved monitoring and evaluation. However, while some health IT systems implementations succeed, the majority are likely to fail . The greater the personal and organisational change required by a system, the greater the risk of failure. Adverse effects of health IT implementation can include increased time for direct and indirect patient care , the loss of privacy and confidentiality, and possible changes to the doctor–patient relationship . The time commitment involved with learning and implementing new systems may be substantial. The set-up costs of computerisation and implementation of health IT can be large and require ongoing investment. Furthermore, IT is a rapidly evolving science. By the time a large-scale project is completed, technology has often moved on .