Computerized clinical decision support for prescribing: provision does not guarantee uptake
Clinical Decision Support (CDSS) have the potential to enhance clinical decisions with the principal goal of providing high quality healthcare that can enhance patients’ outcomes. Resources used by healthcare professionals should always be knowledge-based in order to offer transformational health care services. Although CDSS has demonstrated to enhance the quality of patient care by linking healthcare professionals with high quality evidence-based medicine it generates concern to learn that even when a CDSS is readily available within a healthcare setting clinicians often fail to adopt its recommendations.
The authors conducted a systematic review of the peer-reviewed literature to explore the barriers to, and facilitators of use CDSS for prescribing. Articles were searched through different databases such as Medline, PreMedline, Embase, CINAHL and PsycINFO. Search was restricted to the review of English-language studies published since 1990. Researchers combined keywords and subject headings to identify computer-based decision support systems with the area of prescribing and medicines use. Full-text versions of relevant articles were retrieved and considered for inclusion if they met certain criteria such as:
- Examined any type of Clinical decision support or evidence based information presented electronically
- Provided guidance on prescribing- related issues such as drug interactions, drug monitoring and treatment recommendations.
- Targeted physicians but necessarily exclusive to this group
- Provided information regarding the barriers, facilitators as well as the uptake of CDSSs for prescribing based on primary data collection methods
Data were extracted from studies on:
1. Study characteristics such as year of publication, the year a study was conducted, clinical settings, and participants.
2. Features from CDSS
- Whether or not the systems were used for information retrieval or if they used prompts, standards, or risk assessment tools.
- How CDSS were accessed
- Whether or not the system was a stand-alone system or integrated into another program
- The type of advice the system gave clinicians
3. Barriers to and aids in the implementation of CDSS
It is important to notice that among the collection methods used in the studies were self-report questionnaires, interviews, focus groups and observation.
Results yielded that most studies explored clinicians' opinions of specific CDSS. It was also noticed that 38 studies were conducted within ambulatory care and 35 were undertaken in North America. It was also reported that 29 studies focused just on the opinions or behaviors of physicians. Among the reported facilitators to CDSS uptake were the endorsement, demonstration and/or communication of the systems' benefits by management, administration or senior clinicians as well as the potential financial incentives.
Among the barriers and limitations addressed by the different studies were:
- Limited computer availability at the point of care impeded CDSS use
- Limited Technical assistance to address hardware and software issues
- Concerns about professional liability and patient privacy
- Ongoing technical problems such as malfunctions, system failures and slow computer speeds as barriers to use
Despite the benefits that CDSS provide to healthcare professionals, there is a wide variability in the implementation of alerts generated by CDSS; availability of hardware, training and technical support represent just few factors affecting the uptake of CDSS.
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