Use of IndiGO individualized clinical guidelines in primary care

Abstract

Objective: To determine if IndiGO individualized clinical guidelines could be implemented in routine practice and assess their effects on care and care experience. Methods: Matched comparison observational design. IndiGO individualized guidelines, based on a biomathematical simulation model, were used in shared decision-making. Physicians and patients viewed risk estimates and tailored recommendations in a dynamic user interface and discussed them for 5-10 min. Outcome measures were prescribing and dispensing of IndiGO-recommended medications, changes in physiological markers and predicted 5-year risk of heart attack and stroke, and physician and patient perceptions. Results: 489 patients using IndiGO were 4.9 times more likely to receive a statin prescription than were matched usual care controls (p=0.015). No effect was observed on prescribing of antihypertensive medications, but IndiGO-using patients were more likely to pick up at least one dispensing (p>0.05). No significant changes were observed in blood pressure or serum lipid levels. Predicted risk of heart attack or stroke decreased 1.6% among patients using IndiGO versus 1.0% among matched controls (p>0.01). Physician and patient experiences were positive to neutral. Limitations: We could not assess the separate effects of individualized guidelines, user interface, and physician-patient discussions. Patient selection could have influenced results. The measure of risk reduction was not independent of the individualized guidelines. Conclusions: IndiGO individualized clinical guidelines were successfully implemented in primary care and were associated with increases in the use of cardioprotective medications and reduction in the predicted risk of adverse events, suggesting that a larger trial could be warranted.