Computerization of Medical Practices for the Enhancement of Therapeutic Effectiveness (COMPETE III)

COMPETE is Canada's original electronic medical record research network and specializes in the rigorous development, implementation and evaluation of electronic technologies in health care. COMPETE III will build on COMPETE II to incorporate the latest evidence on:

• the management of diabetes, hypertension, dyslipidemia and previous vascular events,
• improving patient-clinician interactions,
• the use of technology to enhance the quality, safety and efficiency of care and
• motivational strategies to change both patient and clinician behaviour.

Specifically, the researchers will:

• Expand the disease focus to a vascular risk population (diabetes, hypertension, dyslipidemia or previous vascular event);
• Expand the electronic care network beyond patients and primary care providers to also include specialists (physician specialists, specialty nurse clinicians, etc);
• Expand the geographical network from Hamilton area, and Ottawa to include other primary care reform (PCR), Ontario Family Health Networks (OFHN) or EHR using sites;
• Tighten the integration with the leading Ontario EHR products and concentrate on those meeting the new Ontario Smart Systems for Health Clinical Management System specifications,
• Strengthen the clinical decision support by offering evidence-based algorithms specific to the patient, provide specific formulary advice - drug listing, Limited Use prescriptions and codes, Section 8 criteria and form letters;
• Improve the researchers pharmacosurveillance network which pursues reasons for starting and stopping medications by seeking adherence information directly from patients;
• Provide direct links via Internet for patients and clinicians to best evidence about vascular disease,
• Improve the automated telephone support (ATS);
• Support physicians in managing this advanced care network by providing clinical care coordinators, either nurse clinicians or clinical pharmacists;
• Use HL-7 messaging standards as per Canada Health Infoway guidelines;
• Rigorously evaluate the cost-effectiveness of our package intervention in order to provide specific advice to health planners and payers on costs and benefits.

Inclusion criteria

• 55 years of age and over
• Regular patients of a family physician's office (at least one visit in the last 12 months)
• Vascular disease (previous myocardial infarction, stroke, peripheral vascular disease, coronary artery disease) or at least one of the following vascular risk factors (hypertension, hypercholesterolemia, diabetes)

Exclusion criteria

• Non-English speaking
• Cognitive impairment