A usability study to improve a clinical decision support system for the prescription of antibiotic drugs

Akhloufi, H.; Verhaegh, Suzanne J. C.; Jaspers, Monique W. M.; Melles∗, Damian C.; Sijs, Heleen van der; Verbon, Annelies

doi:10.1371/journal.pone.0223073

Cited by 22 publications

(24 citation statements)

References 34 publications

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“…Most (n = 17/29) of the problems were cosmetic problems or minor problems. Eighteen (out of 29) of the usability categories could have an ordering error as a result [ 27 ]. To improve this the system was redesigned by enlarging information icons, introducing calculators, retrieving more patient information automatically from the hospital information system and introducing new options, such as the option to review the culture history in the final screen when an antibiotic advice is generated.…”

Section: Resultsmentioning

confidence: 99%

“…In addition we also included several infectious diseases on request of physicians. We performed a usability study as part of the development and evaluation phase [ 27 ], resulting in stakeholders being engaged in the further development and fine-tuning of the CDSS. The results of the usability study enabled us to make the CDSS more specific to users’ needs (for example by adding calculators).…”

Section: Methodsmentioning

confidence: 99%

“…To improve lay-out and functionality we performed a usability study [ 27 ]. We used a user-based usability evaluation method, where participants had to verbalize their thoughts during the execution of a set of specified tasks using the CDSS.…”

Section: Methodsmentioning

confidence: 99%

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The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

Akhloufi

Sijs

Melles∗

et al. 2022

BMC Med Inform Decis Mak

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Background To describe and evaluate a clinical decision support system (CDSS) for empirical antibiotic therapy using a systematic framework. Methods A reporting framework for behavior change intervention implementation was used, which includes several domains: development, evaluation and implementation. Within the development domain a description is given of the engagement of stakeholders, a rationale for how the CDSS may influence antibiotic prescribing and a detailed outline of how the system was developed. Within the evaluation domain a technical validation is performed and the interaction between potential users and the CDSS is analyzed. Within the domain of implementation a description is given on how the CDSS was tested in the real world and the strategies that were used for implementation and adoption of the CDSS. Results Development: a CDSS was developed, with the involvement of stakeholders, to assist empirical antibiotic prescribing by physicians. Evaluation: Technical problems were determined during the validation process and corrected in a new CDSS version. A usability study was performed to assess problems in the system-user interaction. Implementation: In 114 patients the antibiotic advice that was generated by the CDSS was followed. For 54 patients the recommendations were not adhered to. Conclusions This study describes the development and validation of a CDSS for empirical antibiotic therapy and shows the usefulness of the systematic framework for reporting CDSS interventions. In addition it shows that CDSS recommendations are not always adhered to which is associated with incorrect use of the system.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

Akhloufi

Sijs

Melles∗

et al. 2022

BMC Med Inform Decis Mak

Self Cite

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“…A convenience sample of intervention participants was invited to participate in an accompanied shopping trip whereby the lead author observed them doing their usual supermarket shopping, using the think-aloud method that attempts to access and record participants’ inner speech, the transformation of thought processes into words [ 45 ]. The think-aloud method has been widely used in the design and evaluation of digital interventions [ 46 , 47 ] and to explore consumers’ food choice behaviors [ 48 - 51 ]. The accompanied shopping trip was followed by a one-on-one interview about the participants’ experiences of the intervention.…”

Section: Methodsmentioning

confidence: 99%

A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial

Riches¹,

Piernas²,

Aveyard³

et al. 2021

JMIR Mhealth Uhealth

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Background A high-salt diet is a risk factor for hypertension and cardiovascular disease; therefore, reducing dietary salt intake is a key part of prevention strategies. There are few effective salt reduction interventions suitable for delivery in the primary care setting, where the majority of the management and diagnosis of hypertension occurs. Objective The aim of this study is to assess the feasibility of a complex behavioral intervention to lower salt intake in people with elevated blood pressure and test the trial procedures for a randomized controlled trial to investigate the intervention’s effectiveness. Methods This feasibility study was an unblinded, randomized controlled trial of a mobile health intervention for salt reduction versus an advice leaflet (control). The intervention was developed using the Behavior Change Wheel and comprised individualized, brief advice from a health care professional with the use of the SaltSwap app. Participants with an elevated blood pressure recorded in the clinic were recruited through primary care practices in the United Kingdom. Primary outcomes assessed the feasibility of progression to a larger trial, including follow-up attendance, fidelity of intervention delivery, and app use. Secondary outcomes were objectively assessed using changes in salt intake (measured via 24-hour urine collection), salt content of purchased foods, and blood pressure. Qualitative outcomes were assessed using the think-aloud method, and the process outcomes were evaluated. Results A total of 47 participants were randomized. All progression criteria were met: follow-up attendance (45/47, 96%), intervention fidelity (25/31, 81%), and app use (27/31, 87%). There was no evidence that the intervention significantly reduced the salt content of purchased foods, salt intake, or blood pressure; however, this feasibility study was not powered to detect changes in secondary outcomes. Process and qualitative outcomes demonstrated that the trial design was feasible and the intervention was acceptable to both individuals and practitioners and positively influenced salt intake behaviors. Conclusions The intervention was acceptable and feasible to deliver within primary care; the trial procedures were practicable, and there was sufficient signal of potential efficacy to change salt intake. With some improvements to the intervention app, a larger trial to assess intervention effectiveness for reducing salt intake and blood pressure is warranted. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 20910962; https://www.isrctn.com/ISRCTN20910962

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“…It is not easy to display the recommended antibiotics and their properties in a readily usable interface [16,17]. In the context of antibiotic treatment, several kinds of interface have been used, including textual formats [18,19], tables [19], diagrams [20], hypertextual links [21], and tick boxes [18]. Outside the domain of medicine, e-commerce interfaces (such as those used by e-commerce organizations like Booking, eBay, and Amazon) are widespread and make it possible for consumers to compare particular parameters between products.…”

Section: Introductionmentioning

confidence: 99%

A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach

Madar¹,

Ugon²,

Ivanković³

et al. 2021

J Med Internet Res

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Background Antibiotic misuse is a serious public health problem worldwide. National health authorities release clinical practice guidelines (CPGs) to guide general practitioners (GPs) in their choice of antibiotics. However, despite the large-scale dissemination of CPGs, GPs continue to prescribe antibiotics that are not recommended as first-line treatments. This nonadherence to recommendations may be due to GPs misunderstanding the CPGs. A web interface displaying antibiotic prescription recommendations and their justifications could help to improve the comprehensibility and readability of CPGs, thereby increasing the adoption of recommendations regarding antibiotic treatment. Objective This study aims to design and evaluate a web interface for antibiotic prescription displaying both the recommended antibiotics and their justifications in the form of antibiotic properties. Methods A web interface was designed according to the same principles as e-commerce interfaces and was assessed by 117 GPs. These GPs were asked to answer 17 questions relating to the usefulness, user-friendliness, and comprehensibility and readability of the interface, and their satisfaction with it. Responses were recorded on a 4-point Likert scale (ranging from “absolutely disagree” to “absolutely agree”). At the end of the evaluation, the GPs were allowed to provide optional, additional free comments. Results The antibiotic prescription web interface consists of three main sections: a clinical summary section, a filter section, and a recommended antibiotics section. The majority of GPs appreciated the clinical summary (90/117, 76.9%) and filter (98/117, 83.8%) sections, whereas 48.7% (57/117) of them reported difficulty reading some of the icons in the recommended antibiotics section. Overall, 82.9% (97/117) of GPs found the display of drug properties useful, and 65.8% (77/117) reported that the web interface improved their understanding of CPG recommendations. Conclusions The web interface displaying antibiotic recommendations and their properties can help doctors understand the rationale underlying CPG recommendations regarding antibiotic treatment, but further improvements are required before its implementation into a clinical decision support system.

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A usability study to improve a clinical decision support system for the prescription of antibiotic drugs

Cited by 22 publications

References 34 publications

The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

A Mobile Health Salt Reduction Intervention for People With Hypertension: Results of a Feasibility Randomized Controlled Trial

A Web Interface for Antibiotic Prescription Recommendations in Primary Care: User-Centered Design Approach

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