Reese Thomas J, Del Fiol Guilherme, Morgan Keaton, Hurwitz Jason T, Kawamoto Kensaku, Gomez-Lumbreras Ainhoa, Brown Mary L, Thiess Henrik, Vazquez Sara R, Nelson Scott D, Boyce Richard, Malone Daniel
Vanderbilt University, Nashville, TN, United States.
University of Utah, Salt Lake City, UT, United States.
JMIR Hum Factors. 2021 Oct 26;8(4):e28618. doi: 10.2196/28618.
Exposure to life-threatening drug-drug interactions (DDIs) occurs despite the widespread use of clinical decision support. The DDI between warfarin and nonsteroidal anti-inflammatory drugs is common and potentially life-threatening. Patients can play a substantial role in preventing harm from DDIs; however, the current model for DDI decision-making is clinician centric.
This study aims to design and study the usability of DDInteract, a tool to support shared decision-making (SDM) between a patient and provider for the DDI between warfarin and nonsteroidal anti-inflammatory drugs.
We used an SDM framework and user-centered design methods to guide the design and usability of DDInteract-an SDM electronic health record app to prevent harm from clinically significant DDIs. The design involved iterative prototypes, qualitative feedback from stakeholders, and a heuristic evaluation. The usability evaluation included patients and clinicians. Patients participated in a simulated SDM discussion using clinical vignettes. Clinicians were asked to complete eight tasks using DDInteract and to assess the tool using a survey adapted from the System Usability Scale.
The designed DDInteract prototype includes the following features: a patient-specific risk profile, dynamic risk icon array, patient education section, and treatment decision tree. A total of 4 patients and 11 clinicians participated in the usability study. After an SDM session where patients and clinicians review the tool concurrently, patients generally favored pain treatments with less risk of gastrointestinal bleeding. Clinicians successfully completed the tasks with a mean of 144 (SD 74) seconds and rated the usability of DDInteract as 4.32 (SD 0.52) of 5.
This study expands the use of SDM to DDIs. The next steps are to determine if DDInteract can improve shared decision-making quality and to implement it across health systems using interoperable technology.
尽管临床决策支持已广泛应用，但仍会出现危及生命的药物相互作用（DDIs）。华法林与非甾体抗炎药之间的药物相互作用很常见，且可能危及生命。患者在预防药物相互作用造成的伤害方面可发挥重要作用；然而，当前的药物相互作用决策模式是以临床医生为中心的。
本研究旨在设计并研究DDInteract工具的可用性，该工具用于支持患者与医疗服务提供者之间就华法林与非甾体抗炎药之间的药物相互作用进行共同决策（SDM）。
我们使用共同决策框架和以用户为中心的设计方法来指导DDInteract的设计和可用性——这是一款用于预防具有临床意义的药物相互作用造成伤害的共同决策电子健康记录应用程序。设计过程包括迭代原型、利益相关者的定性反馈以及启发式评估。可用性评估包括患者和临床医生。患者使用临床案例参与模拟的共同决策讨论。临床医生被要求使用DDInteract完成八项任务，并使用从系统可用性量表改编而来的调查问卷对该工具进行评估。
设计的DDInteract原型包括以下功能：患者特定风险概况、动态风险图标阵列、患者教育板块和治疗决策树。共有4名患者和11名临床医生参与了可用性研究。在患者和临床医生同时查看该工具的共同决策环节之后，患者通常倾向于选择胃肠道出血风险较低的止痛治疗方法。临床医生平均用时144（标准差74）秒成功完成任务，并将DDInteract的可用性评为5分中的4.32（标准差0.52）。
本研究将共同决策的应用扩展到了药物相互作用领域。下一步是确定DDInteract是否能提高共同决策质量，并使用可互操作技术在各医疗系统中实施该工具。
