Respiratory Division, The George Institute for Global Health, Sydney, NSW, Australia.
Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia.
NPJ Prim Care Respir Med. 2022 Aug 20;32(1):29. doi: 10.1038/s41533-022-00291-x.
Breathlessness is a common presenting symptom in practice. This systematic review aimed to evaluate the impact of CDSS on breathlessness and associated diseases in real-world clinical settings. Studies published between 1 January 2000 to 10 September 2021 were systematically obtained from 14 electronic research databases including CENTRAL, Embase, Pubmed, and clinical trial registries. Main outcomes of interest were patient health outcomes, provider use, diagnostic concordance, economic evaluation, and unintended consequences. The review protocol was prospectively registered in PROSPERO (CRD42020163141). A total of 4294 records were screened and 37 studies included of which 30 were RCTs. Twenty studies were in primary care, 13 in hospital outpatient/emergency department (ED), and the remainder mixed. Study duration ranged from 2 weeks to 5 years. Most were adults (58%). Five CDSS were focused on assessment, one on assessment and management, and the rest on disease-specific management. Most studies were disease-specific, predominantly focused on asthma (17 studies), COPD (2 studies), or asthma and COPD (3 studies). CDSS for COPD, heart failure, and asthma in adults reported clinical benefits such as reduced exacerbations, improved quality of life, improved patient-reported outcomes or reduced mortality. Studies identified low usage as the main barrier to effectiveness. Clinicians identified dissonance between CDSS recommendations and real-world practice as a major barrier. This review identified potential benefits of CDSS implementation in primary care and outpatient services for adults with heart failure, COPD, and asthma in improving diagnosis, compliance with guideline recommendations, promotion of non-pharmacological interventions, and improved clinical outcomes including mortality.
呼吸困难是临床上常见的主要症状。本系统综述旨在评估临床实际环境中 CDSS 对呼吸困难和相关疾病的影响。从 14 个电子研究数据库（包括 CENTRAL、Embase、Pubmed 和临床试验注册库）系统地获取了 2000 年 1 月 1 日至 2021 年 9 月 10 日期间发表的研究。主要关注的结果是患者健康结果、提供者使用、诊断一致性、经济评估和意外后果。该综述方案在 PROSPERO（CRD42020163141）中进行了前瞻性注册。共筛选了 4294 条记录，纳入了 37 项研究，其中 30 项为 RCT。20 项研究在初级保健中，13 项在医院门诊/急诊（ED），其余的则混合。研究持续时间从 2 周到 5 年不等。大多数参与者为成年人（58%）。有 5 个 CDSS 专注于评估，1 个专注于评估和管理，其余的则专注于特定疾病的管理。大多数研究都是针对特定疾病的，主要集中在哮喘（17 项研究）、COPD（2 项研究）或哮喘和 COPD（3 项研究）。针对 COPD、心力衰竭和哮喘的成人 CDSS 报告了临床益处，如减少恶化、改善生活质量、改善患者报告的结果或降低死亡率。研究发现低使用率是有效性的主要障碍。临床医生发现 CDSS 建议与现实实践之间的不和谐是一个主要障碍。本综述确定了在初级保健和门诊服务中实施 CDSS 对改善心力衰竭、COPD 和哮喘成人的诊断、遵循指南建议、促进非药物干预以及改善临床结局（包括死亡率）的潜在益处。
