Availability of computerised reminders in primary care doesn’t reduce heart-failure repeated hospitalisations

摘要

Computerised reminders can be a support for clinical improvement. We verified their effect on heart-failure (HF) re-hospitalisation rate. Methods and Results: A software (Millewin?) widely used in Italian general practice enbedded an automatic reminder to help general practitioners (GPs) to identify HF patients and to prescribe them with recommended drugs. This reminder system was already activated in the first 2004 release, but required voluntary activation in the successive releases. We had no possibility to know who decided to keep using the reminders. We examined the 2004-2009 HF hospitalisations in Puglia, a Southern Italian Region with a population of over 4000000, and with high HF hospitalisation rate compared with the Italian mean⁷. We compared the hospitalisations for patients cared for by GPs who used Millewin? in 2004 to those of the patients cared for by GPs who never used Millewin?. Data were provided by the local Health Authority, and were extracted from the administrative database. Users of Millewin? cared for 4969 patients (mean age 76 y, sd 12; 48,6% men), the non-users cared for 48781 patients (mean age 76 y, sd 11; 50% men ): no significant difference as far as age and gender are concerned. We examined 17810 patients with > 2 hospitalisation. No difference in re-hospitalisations was observed.Conclusions: Availability of computerised automatic reminders aimed to improve detection of HF patients and prescription of recommended drugs doesn’t decrease repeated hospitalisation; these tools should be probably part of a more complex strategy, such as a long-term audit.