JMIR Publications

ABSTRACT

Background:

Home blood pressure (HBP) is an important parameter that guides clinicians in managing hypertension in patients. However, physicians face challenges in using these records to manage patients regarding access, integration, and interpretation of these records when making clinical decisions. Clinical decision support systems (CDSSs) have been proposed to address these challenges, but current literature reveals significant heterogeneity and gaps in CDSS used for hypertension management.

Objective:

The study aimed to assess the extent of the literature on CDSS that uses HBP to manage patients with hypertension.

Methods:

A scoping review was conducted in PubMed, Embase, and Scopus till April 2024, and it was reported in accordance with the PRISMA-SCr checklist. Studies that used CDSS integrated with HBP monitoring among adult patients with hypertension in outpatient settings were included. Non-English studies were excluded. Outcomes assessed were aggregated into the development theory, components of the CDSS (data capture, processing, output), clinical outcomes, user experiences and implementation strategies.

Results:

Of 4058 articles screened, 33 citations were included. Most studies were conducted in the United States (n=16/33, 48.5%) and were randomised controlled trials (n=21/33, 63.6%). More than half of the CDSS were computerised (n=21/33, 56.8%). Only one study reported a theoretical framework in the CDSS development. BP recording and uploading were predominantly automatic (n=23/33, 69.7%). All computerised CDSS used rule-based algorithms and most incorporated alert triggers for abnormal results (n=19/21, 90.5%). More than a third (n=13/33, 39.4%) of the studies were based on hypertension guidelines. From studies that reported the outcomes, most studies (n=25/29, 86%) reported improved BP and adjustment to hypertension medications (n=16/19, 89%). Patients and clinicians appreciated the convenience and remote monitoring but faced challenges with usability and access in computerised CDSS. All studies using non-computerized CDSS (12/12, 100%) incorporated patient education, while nearly two-thirds of studies using computerized CDSS (13/21, 61.9%) did the same. Clinician training was reported in one computerised CDSS (n=1/21, 4.8%) and three non-computerised CDSS (n=3/12, 25.0%)

Conclusions:

While CDSS holds promise for improving hypertension management, gaps remain in their development and implementation. Future efforts should focus on integrating robust frameworks, aligning with guidelines, enhancing manual data integration, and addressing usability to maximise effectiveness, adoption and user satisfaction.