Toth-Pal Eva, Wårdh Inger, Strender Lars-Erik, Nilsson Gunnar
Centre for Family and Community Medicine, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Inform Prim Care. 2008;16(1):29-39. doi: 10.14236/jhi.v16i1.672.
To explore the influence of a guideline-based computerised decision support system (CDSS) on general practitioners' (GPs') management of patient cases of chronic heart failure in a pragmatic clinical situation. We assessed changes in the GPs' confidence in the diagnosis, their considerations about investigations and medications and the support they perceived from using the CDSS.
Five GPs assessed the medical records of 48 of their own authentic patient cases using a guideline-based CDSS accessible on the internet for the diagnosis and treatment of chronic heart failure, and completed a questionnaire for each case.
Number of cases where the GP reported a change in confidence in the diagnosis, where the GP considered further investigations or changes in medication and the perceived support marked on a visual analogue scale.
The GPs' confidence in the diagnosis changed in 25% of the cases, with equal numbers of increases and decreases in confidence. The GPs considered further investigations in 31% of the cases and medication changes in 19%. Fourteen of the 31 considered investigations and four of the ten considered changes in medications which were in agreement with the CDSS's suggestions. The GPs tended to consider further investigations more often in cases when the CDSS found the diagnosis uncertain. There was a wide range in the values for perceived support, but it could be described as substantial in 35% of the cases.
Using a guideline-based CDSS for the GPs' own patient cases had an impact on the GPs' confidence in the diagnosis of chronic heart failure and their considerations about investigations and medications: they also perceived substantial support in every third case. Applying a CDSS developed using evidence-based guidelines for chronic heart failure in primary care could have a significant influence on GPs' disease management.
探讨基于指南的计算机决策支持系统（CDSS）在实际临床情况下对全科医生（GP）管理慢性心力衰竭患者病例的影响。我们评估了全科医生对诊断的信心变化、他们对检查和药物治疗的考虑以及他们从使用CDSS中感受到的支持。
五名全科医生使用基于指南的可在互联网上访问的CDSS评估了他们自己的48例真实患者病例的病历，用于慢性心力衰竭的诊断和治疗，并为每个病例填写了一份问卷。
全科医生报告诊断信心发生变化的病例数、全科医生考虑进一步检查或药物治疗变化的病例数以及在视觉模拟量表上标记的感知支持。
25%的病例中全科医生对诊断的信心发生了变化，信心增加和减少的病例数相等。31%的病例中全科医生考虑进一步检查，19%的病例中考虑药物治疗变化。31例考虑的检查中有14例，10例考虑的药物治疗变化中有4例与CDSS的建议一致。当CDSS发现诊断不确定时，全科医生在病例中更倾向于考虑进一步检查。感知支持的值范围很广，但在35%的病例中可以描述为很大。
在全科医生自己的患者病例中使用基于指南的CDSS对全科医生对慢性心力衰竭诊断的信心以及他们对检查和药物治疗的考虑产生了影响：他们在每三个病例中也感受到了很大的支持。在初级保健中应用基于循证指南开发用于慢性心力衰竭的CDSS可能会对全科医生的疾病管理产生重大影响。
