Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
Syst Rev. 2017 Dec 13;6(1):255. doi: 10.1186/s13643-017-0627-z.
Integrated reminders within clinical systems have become more prevalent due to the use of electronic health records and evidence demonstrating an increase in compliance within practice. Clinical reminders are assessed for effectiveness on an individual basis, rather than in combination with existing prompts for other conditions. The growing number of prompts may be counter-productive as healthcare professionals are increasingly suffering from "reminder fatigue" meaning many reminders are ignored. This work will review the qualitative evidence to identify barriers and enablers of existing prompts found within computerised decision support systems. Our focus will be on primary care where clinicians have to negotiate a plethora of reminders as they deal with increasingly complex patients and sophisticated treatment regimes. The review will provide a greater understanding of existing systems and the way clinicians interact with them to inform the development of more effective and targeted clinical reminders.
A comprehensive search using piloted terms will be used to identify relevant literature from 1960 (or commencement of database) to 2017. MEDLINE, MEDLINE In Process, EMBASE, HMIC, PsycINFO, CDSR DARE, HTA, CINAHL and CPCI, will be searched, as well as grey literature and references and citations of included papers. Manuscripts will be assessed for eligibility, bias and quality using the CASP tool with narrative data being included and questionnaire based studies excluded. Inductive thematic analysis will be performed in order to produce a conceptual framework defining the key barriers around integrated clinical reminders.
Indications of alert and reminder fatigue are found throughout the current literature. However, this has not been fully investigated using a robust qualitative approach, particularly in a rapidly growing body of evidence. This review will aid people forming new clinical systems so that alerts can be incorporated appropriately.
PROSPERO: CRD42016029418.
由于电子健康记录的使用以及在实践中提高依从性的证据，临床系统中的综合提醒变得更加普遍。临床提醒是根据个体进行评估的，而不是与其他疾病的现有提示相结合。由于医疗保健专业人员越来越受到“提醒疲劳”的影响，即许多提醒被忽略，因此不断增加的提示数量可能适得其反。这项工作将审查定性证据，以确定计算机化决策支持系统中现有的提示存在的障碍和促进因素。我们的重点将放在初级保健上，因为临床医生在处理越来越复杂的患者和复杂的治疗方案时，必须应对大量的提醒。该综述将提供对现有系统的更深入了解以及临床医生与之交互的方式，以告知更有效和有针对性的临床提醒的开发。
使用试点术语进行全面搜索，以确定从 1960 年（或数据库开始）到 2017 年的相关文献。将搜索 MEDLINE、MEDLINE In Process、EMBASE、HMIC、PsycINFO、CDSR DARE、HTA、CINAHL 和 CPCI，以及灰色文献和纳入文献的参考文献和引文。使用 CASP 工具评估手稿的资格、偏倚和质量，纳入叙述性数据并排除基于问卷的研究。将进行归纳主题分析，以生成一个概念框架，定义综合临床提醒的关键障碍。
当前文献中到处都有警报和提醒疲劳的迹象。然而，这尚未通过稳健的定性方法进行充分研究，特别是在快速发展的证据体中。本综述将有助于人们建立新的临床系统，以便可以适当地纳入警报。
PROSPERO：CRD42016029418。
