Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients

Abstract

BackgroundClinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).MethodsA questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.ResultsThe response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).ConclusionsBoth cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.

A Critical Review of the Theoretical Frameworks and the Conceptual Factors in the Adoption of Clinical Decision Support Systems

“…It was alluded that this was probably due to the personality of physicians 19 and the nature of their independent practices. 23 Other concepts such as relevance of task to be carried out (fitness 11,29 and importance of the task 29 ), perceived benefits (users, 20,24,[26][27][28] patients, 20,24 or general benefits such as improved communication, 3,26,32 consistent care, 26 or time saving 3 ), trustability (trust in the CDSS 23,24,26,29 and credibility of the CDSS 26 ), professionalism (sense of being in control 29 and responsibility 23 ), and emotions 3,11,24,26 also played a significant role in the adoption of CDSS. During concept categorization, we noted that the subconcepts found to have significance within each of the concepts were very diverse (Table 4).…”

“…The study populations were sampled from various types of settings such as the regional healthcare system, 26 hospitals, 19,25,[28][29][30][31][32] medical centers, 21 primary care, 3,22,24 and clinics. 11,20,23,27 Two of the studies examined the same population and setting but with different study emphases 11,20 : one targeted its research on how an organization affected the adoption of CDSS, 20 whereas the other looked into the overall factors affecting adoption of CDSS by nurses. 11 The CDSSs were all developed for voluntary use by either nurses or physicians alone, or both, or with other allied health professionals, except for two that required mandatory use by nurses.…”

“…3 The social aspects of interactions with the CDSS were studied using the sociotechnology theory, which leverages on understanding users' experiences with the CDSS in relationship to the patient population served. 32 Other studies attempted to understand the adoption of the CDSS from the perspective of knowledge, attitude, and behavior, 23,27 where knowledge and its management are viewed as positive facilitators for adoption. 23…”

“…The frameworks used were constructs of the hybrids of the Technology Acceptance Model (TAM), 19,21,24,25,30,31 theory of planned behavior and intrinsic motivation, 29 hybrid theory of diffusion of innovation, 3,26 Cabana's framework, 27 sociotechnology analysis, 11,32 organization theory, 20 CDSS evaluation framework, 22 and self-constructed model 23,28 to inform their frameworks ( Table 2).…”

“…32 For the purpose of this study, only the term clinical decision support system was used in order to avoid confusion of names. The CDSSs studied were designed to support a wide range of decisions such as diagnosis and nursing care plan, 28 clinical practice guidelines 26,30 or protocols, 29 diagnosis and treatments, 3,11,[19][20][21][22][23][24][25]32 rehabilitation, 27 and reminder systems. 31 Twelve of the 16 studies were conducted in Western countries (the United States, the United Kingdom, the Netherlands, Spain, and Australia).…”