The development and evaluation of a computerised decision support system for primary care based upon 'patient profile decision analysis'

Abstract

Objective To develop and evaluate in primary care a computerised decision support system for the management of stroke patients based upon 'patient profile decision analysis'. Design The decision support system incorporated the findings of 960 Markov models examining the decision to prescribe aspirin in the secondary prevention of stroke. The models reflected each combination of nine risk factors that determined a patient's profile. The evaluation comprised a qualitative interview and a questionnaire administered before and after the general practitioners (GPs) were given access to the support system. Setting Primary care. Participants 15 GPs from the West Midlands. Main outcome measures Decision certainty scoring of hypothetical patient vignettes. Qualitative perceptions of the applicability and acceptability of the system for primary care.Results After using the system, GPs were more certain of their decision making and made decisions more in line with national guidelines. Quantitative results further suggested that the system made decision making easier, improved feelings of being supported, improved the quality of decision making and increased satisfaction. Qualitative themes included that GPs thought the system could clarify their own decision making and improve GP-patient dialogue. Conclusions The feasibility of individualised decision analysis for general practice has been questioned. Patient profile decision analysis, however, may be a valuable means of harnessing some of the advantages of the methodology to produce more patient-specific guidelines for primary care.

Factors that impact the adoption of clinical decision support systems (CDSS) in healthcare settings for evidence-based decision making

“…We found that primary care clinicians perceive ease of use to be the most important feature for adoption of CDSS. These results concur with previous studies on adoption of technology in primary care, and is believed to be related to limited consultation time, workload, computer self-e cacy and patients' expectations in primary care [27,35]. Due to time constraints and workload pressure, general practitioners may avoid using CDSS due to risk of encountering irrelevant and overwhelming amount of information, as well as compromising on direct communication with patients [36,37].…”

Perceived difficulty and appropriateness of decision making by General Practitioners: a systematic review of scenario studies

“…Five of the 152 studies assessed the perceived difficulty of the GPs’ decisions [ 16 - 20 ]. One did not report the difficulty data [ 18 ], leaving four studies to be analysed.…”

Pharmacotherapy in the ageing patient: The impact of age per se (A review)

“…Some examples include the 'Computerised Antithrombotic Risk Assessment Tool' (CARAT) , Asthma Crystal Byte (Neville et al, 2000), 'clinical decision support of hypertension management' (Montgomery et al, 2000), pharmacokinetic-based gentamicin prescribing (Hwang et al, 2004), and the 'decision support for primary care' tool (Short et al, 2003). For such tools to be effective and relevant, they need to enable comprehensive patient assessment, so that decision-making is patient-oriented; to this end, patient age should only be one of many factors involved in the assessment.…”