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BMC Family Practice

, 16:141

First Online: 16 October 2015Received: 14 March 2015Accepted: 08 October 2015

Abstract

BackgroundTrials evaluating the effects of interventions usually provide little insight into the factors responsible for lack of changes in desired outcomes. A process evaluation alongside a trial can shed light on the mechanisms responsible for the outcomes of a trial. The aim of this study was to investigate exposure to and experiences with a computerized decision support system CDSS intervention, in order to gain insight into the intervention’s impact and to provide suggestions for improvement.

MethodsA process evaluation was conducted as part of a large-scale cluster-randomized controlled trial investigating the effects of the CDSS NHGDoc on quality of care. Data on exposure to and experiences with the intervention were collected during the trial period among participants in both the intervention and control group - whenever applicable - by means of the NHGDoc server and an electronic questionnaire. Multiple data were analyzed using descriptive statistics.

ResultsNinety-nine percent n = 229 of the included practices generated data for the NHGDoc server and 50 % n = 116 responded to the questionnaire: both general practitioners GPs; n = 112; 49 % and practice nurses PNs; n = 52; 37 % participated. The actual exposure to the NHGDoc system and specific heart failure module was limited with 52 % of the GPs and 42 % of the PNs reporting to either never or rarely use the system. Overall, users had a positive attitude towards CDSSs. The most perceived barriers to using NHGDoc were a lack of learning capacity of the system, the additional time and work it requires to use the CDSS, irrelevant alerts, too high intensity of alerts and insufficient knowledge regarding the system.

ConclusionsSeveral types of barriers may have negatively affected the impact of the intervention. Although users are generally positive about CDSSs, a large share of them is insufficiently aware of the functions of NHGDoc and, finds the decision support not always useful or relevant and difficult to integrate into daily practice. In designing CDSS interventions we suggest to more intensely involve the end-users and increase the system’s flexibility and learning capacity. To improve implementation a proper introduction of a CDSS among its target group including adequate training is advocated.

Trial registrationClinical trials NCT01773057.

KeywordsClinical decision support Clinical practice guidelines Primary care Process evaluation Barriers AbbreviationsCDSSComputerized decision support system

PCPPrimary care practitioner

GPGeneral practitioner

PNPractice nurse

NHGDutch College of General Practitioners

EHRSElectronic health record system

Electronic supplementary materialThe online version of this article doi:10.1186-s12875-015-0364-0 contains supplementary material, which is available to authorized users.

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Autor: Marjolein Lugtenberg - Dennis Pasveer - Trudy van der Weijden - Gert P. Westert - Rudolf B. Kool

Fuente: https://link.springer.com/



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