Development of a prototype clinical decision support tool for osteoporosis disease management: a qualitative study of focus groups

Abstract

BackgroundOsteoporosis affects over 200 million people worldwide, and represents a significant cost burden. Although guidelines are available for best practice in osteoporosis, evidence indicates that patients are not receiving appropriate diagnostic testing or treatment according to guidelines. The use of clinical decision support systems (CDSSs) may be one solution because they can facilitate knowledge translation by providing high-quality evidence at the point of care. Findings from a systematic review of osteoporosis interventions and consultation with clinical and human factors engineering experts were used to develop a conceptual model of an osteoporosis tool. We conducted a qualitative study of focus groups to better understand physicians' perceptions of CDSSs and to transform the conceptual osteoporosis tool into a functional prototype that can support clinical decision making in osteoporosis disease management at the point of care.MethodsThe conceptual design of the osteoporosis tool was tested in 4 progressive focus groups with family physicians and general internists. An iterative strategy was used to qualitatively explore the experiences of physicians with CDSSs; and to find out what features, functions, and evidence should be included in a working prototype. Focus groups were conducted using a semi-structured interview guide using an iterative process where results of the first focus group informed changes to the questions for subsequent focus groups and to the conceptual tool design. Transcripts were transcribed verbatim and analyzed using grounded theory methodology.ResultsOf the 3 broad categories of themes that were identified, major barriers related to the accuracy and feasibility of extracting bone mineral density test results and medications from the risk assessment questionnaire; using an electronic input device such as a Tablet PC in the waiting room; and the importance of including well-balanced information in the patient education component of the osteoporosis tool. Suggestions for modifying the tool included the addition of a percentile graph showing patients' 10-year risk for osteoporosis or fractures, and ensuring that the tool takes no more than 5 minutes to complete.ConclusionsFocus group data revealed the facilitators and barriers to using the osteoporosis tool at the point of care so that it can be optimized to aid physicians in their clinical decision making.

Primary care physicians’ views on osteoporosis management: a qualitative study

“…Physicians in our study reported the same main reasons for not using FRAX as family physicians and general internists in a previous study [30], including poor access to clinical decision support systems. Decision support tools need to be easily accessible and user-friendly to achieve their intended level of use [31].…”

Qualitative Insights from the Osteoporosis Research: A Narrative Review of the Literature

“…As part of prototype development of a clinical decision support system for an osteoporosis screening tool, focus groups with general practitioners were conducted in Canada [60]. Practitioners expressed concerns about patients' understanding; technological and time, resources, and process issues [60]. Furthermore, there were concerns that osteoporosis screening might disrupt the actual intended reason for the visit.…”

Application of the Knowledge-to-Action and Medical Research Council frameworks in the development of an osteoporosis clinical decision support tool

“…For example, the tool development process considered not only empirical evidence to build the prototype but also relied on input from a multidisciplinary group of experts (e.g., human factors' engineers, health information technologists, knowledge translation experts, and osteoporosis specialists). Secondly, both frameworks were used to guide the selection of knowledge relevant to osteoporosis disease management (i.e., systematic review [32]), and to ensure that all tool development studies (i.e., focus groups, and usability studies) were appropriately and rigorously conducted [33,39]. We tested the usability of all three components of the osteoporosis tool (with relevant end users) with as many cycles of iterations as was needed to eliminate problems and errors [39].…”

“…We conducted a qualitative study of focus groups with family physicians and general internists to obtain their perceptions about clinical decision support systems, and to identify the components of the osteoporosis tool [33]. These findings were then used to transform the conceptual design into a functional, multicomponent prototype tool consisting of three components (see Appendix A at www.jclinepi.com): …”