Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, UK.
Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Road, Manchester, M13 9PL, UK.
BMC Med Inform Decis Mak. 2018 Nov 7;18(1):93. doi: 10.1186/s12911-018-0661-3.
Technological support may be crucial in optimizing healthcare professional practice and improving patient outcomes. A focus on electronic health records has left other technological supports relatively neglected. Additionally, there has been no comparison between different types of technology-based interventions, and the importance of delivery setting on the implementation of technology-based interventions to change professional practice. Consequently, there is a need to synthesise and examine intervention characteristics using a methodology suited to identifying important features of effective interventions, and the barriers and facilitators to implementation. Three aims were addressed: to identify interventions with a technological component that are successful at changing professional practice, to determine if and how such interventions are theory-based, and to examine barriers and facilitators to successful implementation.
A literature review informed by realist review methods was conducted involving a systematic search of studies reporting either: (1) behavior change interventions that included technology to support professional practice change; or (2) barriers and facilitators to implementation of technological interventions. Extracted data was quantitative and qualitative, and included setting, target professionals, and use of Behaviour Change Techniques (BCTs). The primary outcome was a change in professional practice. A thematic analysis was conducted on studies reporting barriers and facilitators of implementation.
Sixty-nine studies met the inclusion criteria; 48 (27 randomized controlled trials) reported behavior change interventions and 21 reported practicalities of implementation. The most successful technological intervention was decision support providing healthcare professionals with knowledge and/or person-specific information to assist with patient management. Successful technologies were more likely to operationalise BCTs, particularly "instruction on how to perform the behavior". Facilitators of implementation included aligning studies with organisational initiatives, ensuring senior peer endorsement, and integration into clinical workload. Barriers included organisational challenges, and design, content and technical issues of technology-based interventions.
Technological interventions must focus on providing decision support for clinical practice using recognized behavior change techniques. Interventions must consider organizational context, clinical workload, and have clearly defined benefits for improving practice and patient outcomes.
技术支持对于优化医疗专业人员的实践和改善患者的治疗效果至关重要。目前的研究重点主要集中在电子病历上，而相对忽视了其他技术支持手段。此外，目前尚未对不同类型的基于技术的干预措施进行比较，也没有研究实施基于技术的干预措施以改变专业实践时，交付环境的重要性。因此，需要使用一种适合确定有效干预措施重要特征的方法来综合和检查干预措施的特征，并研究实施过程中的障碍和促进因素。本研究有三个目标：确定能够成功改变专业实践的具有技术成分的干预措施；确定这些干预措施是否以及如何基于理论；并检查成功实施的障碍和促进因素。
本研究采用基于真实审查方法的文献综述，对报道以下内容的研究进行了系统检索：（1）包含支持专业实践变革的技术的行为改变干预措施；或（2）技术干预措施实施的障碍和促进因素。提取的数据包括定量和定性数据，包括设置、目标专业人员以及行为改变技术（BCTs）的使用情况。主要结果是专业实践的改变。对报告实施障碍和促进因素的研究进行了主题分析。
共有 69 项研究符合纳入标准；其中 48 项（27 项随机对照试验）报道了行为改变干预措施，21 项报道了实施的实际情况。最成功的技术干预措施是决策支持，为医疗保健专业人员提供知识和/或特定于个人的信息，以协助患者管理。成功的技术更有可能实现行为改变技术，特别是“关于如何执行行为的指导”。实施的促进因素包括使研究与组织倡议保持一致、确保高级同行的认可以及将其整合到临床工作负荷中。障碍包括组织方面的挑战，以及基于技术的干预措施的设计、内容和技术问题。
技术干预措施必须专注于通过使用公认的行为改变技术为临床实践提供决策支持。干预措施必须考虑组织背景、临床工作负荷，并明确界定改善实践和患者结果的好处。
