Implementation of multiple-domain covering computerized decision support systems in primary care: a focus group study on perceived barriersReport as inadecuate




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BMC Medical Informatics and Decision Making

, 15:82

Clinical decision-making, knowledge support systems, and theory

Abstract

BackgroundDespite the widespread availability of computerized decision support systems CDSSs in various healthcare settings, evidence on their uptake and effectiveness is still limited. Most barrier studies focus on CDSSs that are aimed at a limited number of decision points within selected small-scale academic settings. The aim of this study was to identify the perceived barriers to using large-scale implemented CDSSs covering multiple disease areas in primary care.

MethodsThree focus group sessions were conducted in which 24 primary care practitioners PCPs participated general practitioners, general practitioners in training and practice nurses, varying from 7 to 9 per session. In each focus group, barriers to using CDSSs were discussed using a semi-structured literature-based topic list. Focus group discussions were audio-taped and transcribed verbatim. Two researchers independently performed thematic content analysis using the software program Atlas.ti 7.0.

ResultsThree groups of barriers emerged, related to 1 the users’ knowledge of the system, 2 the users’ evaluation of features of the system source and content, format-lay out, and functionality, and 3 the interaction of the system with external factors patient-related and environmental factors. Commonly perceived barriers were insufficient knowledge of the CDSS, irrelevant alerts, too high intensity of alerts, a lack of flexibility and learning capacity of the CDSS, a negative effect on patient communication, and the additional time and work it requires to use the CDSS.

ConclusionsMultiple types of barriers may hinder the use of large-scale implemented CDSSs covering multiple disease areas in primary care. Lack of knowledge of the system is an important barrier, emphasizing the importance of a proper introduction of the system to the target group. Furthermore, barriers related to a lack of integration into daily practice seem to be of primary concern, suggesting that increasing the system’s flexibility and learning capacity in order to be able to adapt the decision support to meet the varying needs of different users should be the main target of CDSS interventions.

KeywordsClinical decision support Clinical practice guidelines Primary care Barriers Interventions Implementation AbbreviationsCDSSComputerized decision support system

PCPPrimary care practitioner

GPGeneral practitioner

GP traineeGeneral practitioner in training

PNPractice nurse

DCGPDutch College of General Practitioners NHG in Dutch

EHRSElectronic health record system

ICPC codesInternational Classification of Primary Care codes

NHG lab codesCodes used by the Nederlands Huisartsen Genootschap DCGP in English to classify laboratory and other diagnostic tests and results

ATC codesAnatomical Therapeutic Chemical Classification System codes

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Author: Marjolein Lugtenberg - Jan-Willem Weenink - Trudy van der Weijden - Gert P. Westert - Rudolf B. Kool

Source: https://link.springer.com/



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