Tjeerd van Staa (University of Manchester, GetReal WP2) recently published a report on the opportunities and challenges of pragmatic point-of-care randomised trials using EHR. In the report, experiences with two point-of-care trials are described (statins in patients with hypercholesterolaemia and high cardiovascular risk) and antibiotic use in COPD exacerbations. The project aimed to develop and evaluate methods to implement simple pragmatic trials using routinely collected electronic health records (EHRs) and recruiting patients at the point of care; to identify the barriers and facilitators for general practitioners (GPs) and patients; and to assess the experiences of trial participants.
As part of the project, the researchers installed a new computer programme in 23 approved GP surgeries across England and Scotland. This programme was able to identify which patients were eligible to take part and allowed doctors to sign up relevant participants at the click of a button, saving time and resources. The study team then used the information collected, updated as part of regular medical appointments, to monitor the impact of treatments. The results of the project show that EHR point-of-care trials are feasible, although the recruitment of clinicians is a major challenge owing to the complexity of trial approvals.
The work by Tjeerd van Staa’s team provides insight into how pragmatic trials can be conducted in clinical practice, what barriers have to be overcome and what the key areas for future research are.
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