Exposure to and experiences with a computerized decision support intervention in primary care

Results from a process evaluation

M. Lugtenberg, Dennis Pasveer, Trudy van der Weijden, G.P. Westert, Rudolf B. Kool

Research output: Contribution to journalArticleScientificpeer-review

28 Downloads (Pure)

Abstract

Background
Trials 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.
Methods
A 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.
Results
Ninety-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.
Conclusions
Several 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.
Keywords
Clinical decision support, Clinical practice guidelines, Primary care, Process evaluation, Barriers
Original languageEnglish
Article number141
JournalBMC Family Practice
Volume16
DOIs
Publication statusPublished - 2015

Keywords

  • Clinical decision support
  • Clinical practice guidelines
  • Primary care
  • Process evaluation
  • Barriers

Cite this

@article{1732cc9ad3d24ace8a4cdd26e41d188f,
title = "Exposure to and experiences with a computerized decision support intervention in primary care: Results from a process evaluation",
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.KeywordsClinical decision support, Clinical practice guidelines, Primary care, Process evaluation, Barriers",
keywords = "Clinical decision support, Clinical practice guidelines, Primary care, Process evaluation, Barriers",
author = "M. Lugtenberg and Dennis Pasveer and {van der Weijden}, Trudy and G.P. Westert and Kool, {Rudolf B.}",
year = "2015",
doi = "10.1186/s12875-015-0364-0",
language = "English",
volume = "16",
journal = "BMC Family Practice",
issn = "1471-2296",
publisher = "BioMed Central",

}

Exposure to and experiences with a computerized decision support intervention in primary care : Results from a process evaluation. / Lugtenberg, M.; Pasveer, Dennis; van der Weijden, Trudy; Westert, G.P.; Kool, Rudolf B.

In: BMC Family Practice, Vol. 16, 141, 2015.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Exposure to and experiences with a computerized decision support intervention in primary care

T2 - Results from a process evaluation

AU - Lugtenberg, M.

AU - Pasveer, Dennis

AU - van der Weijden, Trudy

AU - Westert, G.P.

AU - Kool, Rudolf B.

PY - 2015

Y1 - 2015

N2 - 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.KeywordsClinical decision support, Clinical practice guidelines, Primary care, Process evaluation, Barriers

AB - 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.KeywordsClinical decision support, Clinical practice guidelines, Primary care, Process evaluation, Barriers

KW - Clinical decision support

KW - Clinical practice guidelines

KW - Primary care

KW - Process evaluation

KW - Barriers

U2 - 10.1186/s12875-015-0364-0

DO - 10.1186/s12875-015-0364-0

M3 - Article

VL - 16

JO - BMC Family Practice

JF - BMC Family Practice

SN - 1471-2296

M1 - 141

ER -