Mobile computing acceptance factors in the healthcare industry: a structural equation model.

Objectives: The authors investigated the extent to which changes occurred between 1992 and 2005 in the ways that primary care physicians seek answers to clinical problems. What search strategies are used? How much time is spent on them? How do primary care physicians evaluate various search activities and information sources? Can a clinical librarian be useful to a primary care physician?

Methods: Twenty-one original research papers and three literature reviews were examined. No systematic reviews were identified.

Results: Primary care physicians seek answers to only a limited number of questions about which they first consult colleagues and paper sources. This practice has basically not changed over the years despite the enormous increase in and better accessibility to electronic information sources. One of the major obstacles is the time it takes to search for information. Other difficulties primary care physicians experience are related to formulating an appropriate search question, finding an optimal search strategy, and interpreting the evidence found. Some studies have been done on the supporting role of a clinical librarian in general practice. However, the effects on professional behavior of the primary care physician and on patient outcome have not been studied. A small group of primary care physicians prefer this support to developing their own search skills.

Discussion: Primary care physicians have several options for finding quick answers: building a question-and-answer database, consulting filtered information sources, or using an intermediary such as a clinical librarian.

/pdf/how-do-primary-care-physicians-seek-answers-to-clinical-1t0zpn08xr.pdf

How do primary care physicians seek answers to clinical questions? A literature review.

Computerized clinical decision support for prescribing: provision does not guarantee uptake.

Health IT acceptance factors in long-term care facilities: a cross-sectional survey

Objectives To catalogue study designs used to assess the clinical effectiveness of CDSSs and KMSs, to identify features that impact the success of CDSSs/KMSs, to document the impact of CDSSs/KMSs on outcomes, and to identify knowledge types that can be integrated into CDSSs/KMSs Data sources MEDLINE(®), CINAHL(®), PsycINFO(®), and Web of Science(®) Review methods We included studies published in English from January 1976 through December 2010 After screening titles and abstracts, full-text versions of articles were reviewed by two independent reviewers Included articles were abstracted to evidence tables by two reviewers Meta-analyses were performed for seven domains in which sufficient studies with common outcomes were included Results We identified 15,176 articles, from which 323 articles describing 311 unique studies including 160 reports on 148 randomized control trials (RCTs) were selected for inclusion RCTs comprised 475 percent of the comparative studies on CDSSs/KMSs Both commercially and locally developed CDSSs effectively improved health care process measures related to performing preventive services (n = 25; OR 142, 95% confidence interval [CI] 127 to 158), ordering clinical studies (n = 20; OR 172, 95% CI 147 to 200), and prescribing therapies (n = 46; OR 157, 95% CI 135 to 182) Fourteen CDSS/KMS features were assessed for correlation with success of CDSSs/KMSs across all endpoints Meta-analyses identified six new success features: Integration with charting or order entry system Promotion of action rather than inaction No need for additional clinician data entry Justification of decision support via research evidence Local user involvement Provision of decision support results to patients as well as providers Three previously identified success features were confirmed: Automatic provision of decision support as part of clinician workflow Provision of decision support at time and location of decisionmaking Provision of a recommendation, not just an assessment Only 29 (196%) RCTs assessed the impact of CDSSs on clinical outcomes, 22 (149%) assessed costs, and 3 assessed KMSs on any outcomes The primary source of knowledge used in CDSSs was derived from structured care protocols Conclusions Strong evidence shows that CDSSs/KMSs are effective in improving health care process measures across diverse settings using both commercially and locally developed systems Evidence for the effectiveness of CDSSs on clinical outcomes and costs and KMSs on any outcomes is minimal Nine features of CDSSs/KMSs that correlate with a successful impact of clinical decision support have been newly identified or confirmed

Enabling health care decisionmaking through clinical decision support and knowledge management

Barriers to the adoption of computerised decision support systems in general practice consultations: a qualitative study of GPs' perspectives

Background: Despite evidence-based guidelines, aspirin prescribing for the secondary prevention of stroke is sub-optimal. Little is known about why general practitioners do not prescribe aspirin to indicated patients. We sought to identify and describe factors that lead general practitioners (GPs) not to prescribe aspirin to eligible stroke patients. This was the first stage of a study exploring the need for and means of improving levels of appropriate aspirin prescribing. Method: Qualitative interviews with 15 GPs in the West Midlands. Results: Initially, many GPs did not regard their prescribing as difficult or sub-optimal. However on reflection, they gave several reasons that lead to them not prescribing aspirin for eligible patients or being uncertain. These include: difficulties in applying generic guidelines to individuals presenting in consultations, patient resistance to taking aspirin, the prioritisation of other issues in a time constrained consultation and problems in reviewing the medication of existing stroke patients. Conclusion: In order to improve levels of appropriate aspirin prescribing, the nature and presentation risk information available to GPs and patients must be improved. GPs need support in assessing the risks and benefits of prescribing for patients with combinations of complicating risk factors, while means of facilitating improved GP-patient dialogue are required to help address patient uncertainty. A decision analysis based support system is one option. Decision analysis could synthesise current evidence and identify risk data for a range of patient profiles commonly presenting in primary care. These data could then be incorporated into a user-friendly computerised decision support system to help facilitate improved GP-patient communication. Measures of optimum prescribing based upon aggregated prescribing data must be interpreted with caution. It is not possible to assess whether low levels of prescribing reflect appropriate or inappropriate use of aspirin in specific patients where concordance between the GP and the patient is practised.

/pdf/why-are-eligible-patients-not-prescribed-aspirin-in-primary-5a4uehhi5k.pdf

Why are eligible patients not prescribed aspirin in primary care? A qualitative study indicating measures for improvement

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.

https://hijournal.bcs.org/index.php/jhi/article/download/567/579

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

The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88% with vs 38% without PRO feedback) and anxiety (54% with vs 24% without PRO feedback). In post-visit questionnaires, PWH (82%) and providers (82%) indicated that the PRO added value to the visit. 

/pdf/utility-and-impact-of-the-implementation-of-same-day-self-6uwnezji.pdf

Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics

While decision analysis has the potential to improve treatment decisions, the quality of patient specific data has hindered its development. Experience with the General Practice Research Database (...

https://journals.sagepub.com/doi/pdf/10.1177/1460458209353559

Duncan Short

Papers

Barriers to the adoption of computerised decision support systems in general practice consultations: a qualitative study of GPs' perspectives

Why are eligible patients not prescribed aspirin in primary care? A qualitative study indicating measures for improvement

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

Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics

Determining patient characteristics for decision analysis support systems using anonymized electronic patient records.