Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia.
The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia.
Med Decis Making. 2020 May;40(4):428-437. doi: 10.1177/0272989X20926136. Epub 2020 Jun 8.
Inappropriate antibiotic prescribing can lead to antimicrobial resistance and drug side effects. Tools that assist general practitioners (GPs) in prescribing decisions may help to optimize prescribing. The aim of this study was to explore the use, acceptability, and feasibility of a clinical decision support (CDS) tool that incorporates evidence-based guidelines and consumer information that integrates with the electronic medical record (EMR). Eight GPs completed an interview and brief survey after participating in 2 simulated consultations. The survey consisted of demographic questions, perception of realism and representativeness of consultations, Post-Study System Usability Questionnaire, and System Usability Scale. Qualitative data were analyzed using framework analysis. Video data were reviewed, with length of consultation and time spent using the CDS tool documented. Survey responses indicated that all GPs thought the consultations were "real" and representative of real-life consultations; 7 of 8 GPs were satisfied with usability of the tool. Key qualitative findings included that the tool assisted with clinical decision making and informed appropriate antibiotic prescribing. Accessibility and ease of use, including content (guideline and patient education resources), layout, and format, were key factors that determined whether GPs said that they would access the tool in everyday practice. Integration of the tool at multiple sites within the EMR facilitated access to guidelines and assisted in ensuring that the tool fit the clinical workflow. Our CDS tool was acceptable to GPs. Key features required for the tool were easy navigation, clear and useful guideline content, ability to fit into the clinical workflow, and incorporation into the EMR. Piloting of the tool in general practices to assess the impact and feasibility of use in real-world consultations will now be undertaken.
不适当的抗生素处方可能导致抗菌药物耐药和药物副作用。有助于全科医生（GP）做出处方决策的工具可能有助于优化处方。本研究旨在探索使用、接受度和临床决策支持（CDS）工具的可行性，该工具结合了循证指南和整合电子病历（EMR）的消费者信息。8 名全科医生在参与 2 次模拟咨询后完成了访谈和简短调查。该调查包括人口统计学问题、对咨询的现实性和代表性的看法、使用后系统可用性问卷和系统可用性量表。定性数据采用框架分析进行分析。审查了视频数据，并记录了咨询的长度和使用 CDS 工具的时间。调查结果表明，所有全科医生都认为咨询“真实”且代表了现实生活中的咨询；8 名全科医生中有 7 名对工具的可用性感到满意。主要定性发现包括，该工具有助于临床决策并告知适当的抗生素处方。可及性和易用性，包括内容（指南和患者教育资源）、布局和格式，是决定全科医生是否会在日常实践中使用该工具的关键因素。在 EMR 中的多个站点集成工具有助于访问指南，并有助于确保工具符合临床工作流程。我们的 CDS 工具得到了全科医生的认可。工具所需的关键功能包括易于导航、清晰有用的指南内容、适应临床工作流程的能力以及与 EMR 的整合。现在将在全科医生中试用该工具，以评估其在实际咨询中的影响和使用可行性。
