School of Pharmacy, University of Tasmania, Hobart, Tasmania, Australia.
J Clin Pharm Ther. 2013 Dec;38(6):490-7. doi: 10.1111/jcpt.12093. Epub 2013 Aug 29.
Web-based decision support tools have rationalized prescribing of antimicrobials in healthcare settings. Clinicians' acceptance of decision support tools is one of the important factors that determine successful implementation of such tools. This study evaluated the impact of a formative evaluation on the uptake of a web-based antibiotic computerized decision support system (CDSS) by clinicians at a university teaching hospital.
Semi-structured qualitative interviews were conducted with junior and senior doctors and pharmacists. Interviews were transcribed verbatim and reviewed to identify barriers surrounding clinicians' use of the antibiotic CDSS. Recommendations were made to the development team of the studied system regarding system modifications and the implementation strategy. An automated log of the clinicians' use of antibiotic CDSS was generated before and after the formative evaluation.
Interviews of 42 clinicians identified several barriers related to contents and implementation strategy of the antibiotic CDSS. Important differences were observed between senior and junior doctors about various aspects of the antibiotic restriction strategy and applicability of antibiotic CDSS in specialized clinical areas. Recommendations from the formative evaluation study resulted in significant modifications to the contents and implementation strategy of the antibiotic CDSS. A significant increase in uptake of the antibiotic CDSS by clinicians was observed following the formative evaluation.
The formative evaluation approach during the implementation period of the studied antibiotic CDSS increased clinicians' uptake of the system. Formative evaluation may be recommended as a routine strategy to implement future CDSS and related clinical computing applications in hospital settings.
基于网络的决策支持工具已经使医疗环境中的抗菌药物处方合理化。临床医生对接纳决策支持工具的程度是决定这些工具成功实施的重要因素之一。本研究评估了形成性评价对大学教学医院临床医生接受基于网络的抗生素计算机化决策支持系统（CDSS）的影响。
对初级和高级医生和药剂师进行半结构式定性访谈。对访谈进行逐字转录并进行审查，以确定围绕临床医生使用抗生素 CDSS 的障碍。针对所研究系统的开发团队提出了有关系统修改和实施策略的建议。在形成性评价之前和之后，生成了临床医生使用抗生素 CDSS 的自动日志。
对 42 名临床医生的访谈确定了与抗生素 CDSS 的内容和实施策略相关的几个障碍。资深医生和初级医生在抗生素限制策略的各个方面以及抗生素 CDSS 在专业临床领域的适用性方面存在重要差异。形成性评价研究的建议导致抗生素 CDSS 的内容和实施策略发生重大变化。在形成性评价之后，临床医生对抗生素 CDSS 的采用率显著增加。
在研究抗生素 CDSS 的实施期间采用形成性评价方法增加了临床医生对该系统的采用。形成性评价可能被推荐为在医院环境中实施未来的 CDSS 和相关临床计算应用的常规策略。
