Press Releases: Southern California
March 23, 2005
Kaiser Permanente Automated Computer System Gathers Patient Data and Provides Advice on Prescribing
PASADENA, Calif. – Since July 2002, Kaiser Permanente has been testing a computer system that provides physicians with evidence-based recommendations for care.
"The study’s important finding was a small but significant effect on increasing prescriptions of medications to prevent heart attacks and strokes," said Stephen F. Derose, MD, of the Kaiser Permanente Department of Research and Evaluation and the study’s principal author.
The two heart attack medications evaluated were angiotensin-converting enzyme inhibitor (ACEI), a drug used to reduce elevated blood pressure; and HMG-CoA reductase inhibitors, a group of prescription drugs effective in lowering cholesterol. More than 4,000 visits were observed for each medication recommendation.
Published in the May issue of the American Journal of Managed Care, the study was supported by Merck Health Management Services.
To perform the study, the Kaiser Permanente investigators utilized existing databases to obtain patient record information on patients with diabetes, atherosclerotic vascular disease and myocardial infarction. Diabetic patients were identified by outpatient diagnosis or by inpatient discharge codes.
"The system we tested used a computer to generate faxes that were sent to clinics the day before patient appointments," said Derose. "At the same time, pharmacy and laboratory information that the doctor needed, including history of hospitalizations and/or emergency room visits and recommendations for medications and screening tests, were also provided."
Study patients eligible to be given ACEI were men and women 55 to 80 who had not taken ACEI or ARB (angiotensin receptor blockers, drugs that reduce the levels of certain chemicals that narrow blood vessels) in the past 12 months. They were eligible if they were diabetic and had HDL less than 36 milligrams per deciliter (mg/dL), or if their LDL was greater than 130 mg/dL, or had been diagnosed with atherosclerotic vascular disease. Men and women 55 to 80 were eligible for the statin recommendation (statins are drugs that inhibit the manufacture of cholesterol by the liver) if they had no other lipid-lowering drug dispensed in the past six months and had diabetes with HDL greater than 100 mg/dL.
In addition to Derose, the other Southern California Permanente Medical Group (SCPMG) physicians who authored the study are: James R. Dudl, MD, Department of Medicine, San Diego Medical Center; Victor M. Benson, MD, Department of Family Medicine, Harbor City Medical Center; Richard Contreras, MS, Department of Research and Evaluation, Pasadena; Randall K. Nakahiro, PharmD, Pharmacy Services, Downey; and Frederick H. Ziel, MD, Department of Medicine, Woodland Hills Medical Center.
"The system we tested is designed to minimize the number of missed opportunities to treat cardiovascular disease events when they occur during a routine clinic visit," said Derose. "Kaiser Permanente uses the system at clinics where primary care doctors or selected specialists take care of diabetic patients from Riverside to San Diego up to Los Angeles and Ventura County."
About Kaiser Permanente
Kaiser Permanente is America's leading integrated health plan. Founded in 1945, it is a nonprofit, group practice prepayment program with Southern California headquarters in Pasadena, California. Kaiser Permanente serves the health care needs of 3.3 million members in Southern California. Today it encompasses the nonprofit Kaiser Foundation Health Plan, Inc., Kaiser Foundation Hospitals and their subsidiaries, and the for-profit Southern California Permanente Medical Group. Kaiser Permanente's Southern California Region includes more than 49,900 technical, administrative and clerical employees and caregivers, and more than 6,000 physicians representing all specialties. More information about Kaiser Permanente can be found at kaiserpermanente.org.
