Patient facing clinical decision support for high blood pressure control: a patient survey (Preprint)

BACKGROUND High blood pressure (HBP) affects nearly half of adults in the United States and is a major factor in heart attacks, strokes, kidney disease, and other morbidities. To reduce risk, guidelines for HBP contain more than 70 recommendations, including many related to patient behaviors, such as home monitoring and lifestyle changes. Thus, the patient's role in controlling HBP is crucial. Patient-facing clinical decision support (CDS) tools may help patients adhere to evidence-based care but customization is required. OBJECTIVE Our objective was to understand how to adapt CDS to best engage patients in controlling HBP. METHODS We conducted a mixed methods study with two phases: (1) semi-structured interviews with a limited cohort; and (2) a nationwide online survey. Participation in each phase was limited to adults between the ages of 18 and 85 who had been diagnosed with hypertension. The survey included general questions that assessed goal-setting, treatment priorities, medication load, comorbid conditions, satisfaction with BP management, and attitudes towards CDS, and also a series of A/B preference questions using paired information displays to assess perceived trustworthiness of potential CDS user interface options. RESULTS We conducted 17 semi-structured interviews to gather patient needs from CDS, then analyzed results to create a survey of 519 adults with clinically diagnosed HBP. A large majority of participants in both populations reported that blood pressure control was a high priority (80-90%), had monitored blood pressure at home (80-90%), and felt comfortable using technology (70-90%.). Survey respondents found displays with enhanced HBP information more trustworthy (60-80% preferred over simpler displays), especially when incorporating social trust and priorities from providers and patients like them, but had no differences in action taken. CONCLUSIONS Respondents to the survey felt CDS capabilities could help them with HBP control. The enhanced information and social/relational displays were felt to be the most trustworthy yet did not differentiate perceived actions.