Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Darlinghurst, NSW, Australia.
St Vincent's Clinical School, University of NSW, Kensington, NSW, Australia.
Br J Clin Pharmacol. 2021 Mar;87(3):1215-1233. doi: 10.1111/bcp.14496. Epub 2020 Aug 5.
Dose-prediction software can optimise vancomycin therapy, improving therapeutic drug monitoring processes and reducing drug toxicity. Success of software in hospitals may be dependent on prescriber uptake of software recommendations. This study aimed to identify the perceived psychosocial and environmental barriers and facilitators to prescriber acceptance of dose-prediction software.
Semi-structured interviews, incorporating prescribing scenarios, were undertaken with 17 prescribers. Participants were asked to prescribe the next maintenance dose of vancomycin for a scenario(s) and then asked if they would accept a recommendation provided by a dose-prediction software. Interviews further explored opinions of dose-prediction software. Interview transcripts were analysed using an inductive approach to identify themes and the Theoretical Domains Framework was used to synthesise barriers and facilitators to software acceptance.
When presented with software recommendations, half of the participants were comfortable with accepting the recommendation. Key barriers to acceptance of software recommendations aligned with 2 Theoretical Domains Framework domains: Knowledge (uncertainty of software capability) and Beliefs about Consequences (perceived impact of software on clinical outcomes and workload). Key facilitators aligned with 2 domains: Beliefs about Consequences (improved efficiency) and Social Influences (influence of peers). A novel domain, Trust, was identified as influential.
Prescribers reported barriers to acceptance of dose-prediction software aligned with limited understanding of, and scepticism about, software capabilities, as well as concerns about clinical outcomes. Identification of key barriers and facilitators to acceptance provides essential information to design of implementation strategies to support the introduction of this intervention into the workplace.
剂量预测软件可以优化万古霉素治疗，改善治疗药物监测过程并降低药物毒性。软件在医院的成功可能取决于医生对软件建议的接受程度。本研究旨在确定医生接受剂量预测软件的感知心理社会和环境障碍和促进因素。
对 17 名医生进行了半结构化访谈，其中包含了处方情景。要求参与者为一个（多个）情景开下一次万古霉素维持剂量的处方，然后询问他们是否会接受剂量预测软件提供的建议。访谈进一步探讨了对剂量预测软件的看法。使用归纳法分析访谈记录，以确定主题，并使用理论领域框架综合接受软件的障碍和促进因素。
当提出软件建议时，一半的参与者愿意接受建议。接受软件建议的主要障碍与 2 个理论领域框架领域一致：知识（对软件功能的不确定性）和对后果的信念（对软件对临床结果和工作负荷的影响的看法）。主要促进因素与 2 个领域一致：对后果的信念（提高效率）和社会影响（同行的影响）。确定了一个新的领域，即信任，具有影响力。
医生报告的接受剂量预测软件的障碍与对软件功能的理解有限和对其持怀疑态度，以及对临床结果的担忧有关。确定接受的关键障碍和促进因素为设计实施策略提供了必要的信息，以支持将这种干预措施引入工作场所。
