The impact of electronic clinical reminders on medication trends and six-month survival after coronary artery bypass graft surgery in the Veterans Healthcare Administration

Electronic clinical reminders for antihypertensive medications and lipid lowering agents were previously implemented in the VA for patients undergoing CABG surgery. The objective of this study was to determine whether electronic clinical guideline reminders are associated with (a) medication fill rates for antihypertensive and lipid lowering agent medications; and (b) 6-month risk-adjusted survival after CABG surgery.; This was a retrospective cohort study that was conducted using existing patient data from the national VA Pharmacy Benefits Management System and the Continuous Improvement in Cardiac Surgery Program for the time period of October 1999 - September 2005. In addition, a survey was conducted at the 41 VA hospitals that perform cardiac surgery to obtain information regarding clinical guideline reminders at each hospital.; The main outcome measures for this study were the change in medication fill rates for antihypertensive and lipid lowering agents and 6-month risk adjusted survival among CABG patients.; The change in medication fill rates was assessed by comparing the fill rates for a 6-month period prior to the active use of the electronic clinical reminder to twelve months post reminder at each of the cardiac surgery hospitals. There was no significant difference in change in reminder fill rates between the pre- and post-reminder periods for either lipid lowering agents (p = 0.30) and for antihypertensive medications (p = 0.80). A Cox Proportional Hazard Regression model was used to determine the predictors of survival among CABG patients. A comparison of 6-month risk adjusted survival was made between the 6-month time period prior to the clinical reminder versus the 6-month time period after the reminder was actively used. The clinical reminder was not a statistically significant predictor of survival (p = 0.45, hazard ratio = 2.173, confidence intervals 0.294--16.068). Multivariable risk model results indicated that the strongest predictor of 6-month risk adjusted survival was the 180-day mortality risk ratio for CABG patients (Hazard Ratio = 1.088, Cl = 1.068--1.109, p < .0001). The predictor variable of 180-day mortality risk is a validated pre-procedural risk score that included demographic and clinical history variables.; Electronic clinical guideline reminders were not associated with significant increases in medication fill rates or 6-month risk adjusted survival among CABG surgery patients. These results do not support the use of electronic clinical reminders in this setting.