# Implementation of an Integrated, Clinical Decision Support Tool at the Point of Antihypertensive Medication Refill Request to Improve Hypertension Management: Controlled Pre-Post Study

## TL;DR

A clinical decision support tool was implemented to help manage hypertension during medication refills, but it did not significantly improve blood pressure control.

## Contribution

The study evaluates an integrated clinical decision support tool for hypertension management during antihypertensive medication refills.

## Key findings

- The tool did not significantly improve population-level hypertension control after implementation.
- Clinician approval rates remained high, indicating minimal impact on prescribing behavior.
- Future improvements should focus on better integration and clinician engagement.

## Abstract

Improving processes regarding the management of electronic health record (EHR) requests for chronic antihypertensive medication renewals may represent an opportunity to enhance blood pressure (BP) management at the individual and population level.

This study aimed to evaluate the effectiveness of the eRx HTN Chart Check, an integrated clinical decision support tool available at the point of antihypertensive medication refill request, in facilitating enhanced provider management of chronic hypertension.

The study was conducted at two Mayo Clinic sites—Northwest Wisconsin Family Medicine and Rochester Community Internal Medicine practices—with control groups in comparable Mayo Clinic practices. The intervention integrated structured clinical data, including recent BP readings, laboratory results, and visit dates, into the electronic prescription renewal interface to facilitate prescriber decision-making regarding hypertension management. A difference-in-differences (DID) design compared pre- and postintervention hypertension control rates between the intervention and control groups. Data were collected from the Epic EHR system and analyzed using linear regression models.

The baseline BP control rates were slightly higher in intervention clinics. Postimplementation, no significant improvement in population-level hypertension control was observed (DID estimate: 0.07%, 95% CI −4.0% to 4.1%; P=.97). Of the 19,968 refill requests processed, 46% met all monitoring criteria. However, clinician approval rates remained high (90%), indicating minimal impact on prescribing behavior.

Despite successful implementation, the tool did not significantly improve hypertension control, possibly due to competing quality initiatives and high in-basket volumes. Future iterations should focus on enhanced integration with other decision support tools and strategies to improve clinician engagement and patient outcomes. Further research is needed to optimize chronic disease management through EHR-integrated decision support systems.