计算机化临床决策支持系统在初级保健中的处方应用：主要特征和实施影响——证据和差距图方案。
Computerized clinical decision support systems for prescribing in primary care: main characteristics and implementation impact-protocol of an evidence and gap map.
机构信息
Pharmacy Service, University Hospital Virgen del Rocio, Seville, Spain.
Primary Care Pharmacist Service, Sevilla Primary Care District, Seville, Spain.
出版信息
Syst Rev. 2022 Dec 29;11(1):283. doi: 10.1186/s13643-022-02161-6.
BACKGROUND
Computerized clinical decision support systems are used by clinicians at the point of care to improve quality of healthcare processes (prescribing error prevention, adherence to clinical guidelines, etc.) and clinical outcomes (preventive, therapeutic, and diagnostics). Attempts to summarize results of computerized clinical decision support systems to support prescription in primary care have been challenging, and most systematic reviews and meta-analyses failed due to an extremely high degree of heterogeneity present among the included primary studies. The aim of our study will be to synthesize the evidence, considering all methodological factors that could explain these differences, and build an evidence and gap map to identify important remaining research questions.
METHODS
A literature search will be conducted from January 2010 onwards in MEDLINE, Embase, the Cochrane Library, and Web of Science databases. Two reviewers will independently screen all citations, full text, and abstract data. The study methodological quality and risk of bias will be appraised using appropriate tools if applicable. A flow diagram with the screened studies will be presented, and all included studies will be displayed using interactive evidence and gap maps. Results will be reported in accordance with recommendations from the Campbell Collaboration on the development of evidence and gap maps.
DISCUSSION
Evidence behind computerized clinical decision support systems to support prescription use in primary care has so far been difficult to be synthesized. Evidence and gap maps represent an innovative approach that has emerged and is increasingly being used to address a broader research question, where multiple types of intervention and outcomes reported may be evaluated. Broad inclusion criteria have been chosen with regard to study designs, in order to collect all available information. Regarding the limitations, we will only include English and Spanish language studies from the last 10 years, we will not perform a grey literature search, and we will not carry out a meta-analysis due to the predictable heterogeneity of available studies.
SYSTEMATIC REVIEW REGISTRATION
This study is registered in Open Science Framework https://bit.ly/2RqKrWp.
背景
临床医生在护理点使用计算机化临床决策支持系统来提高医疗保健流程的质量（预防处方错误、遵守临床指南等）和临床结果（预防、治疗和诊断）。总结支持初级保健中处方的计算机化临床决策支持系统的结果一直具有挑战性，并且由于纳入的初级研究之间存在极高的异质性，大多数系统评价和荟萃分析都失败了。我们研究的目的将是综合证据，考虑所有可能解释这些差异的方法学因素，并构建证据和差距图，以确定重要的剩余研究问题。
方法
从 2010 年 1 月开始，我们将在 MEDLINE、Embase、Cochrane 图书馆和 Web of Science 数据库中进行文献检索。两位审查员将独立筛选所有引文、全文和摘要数据。如果适用，将使用适当的工具评估研究方法学质量和偏倚风险。将呈现筛选研究的流程图，并使用交互式证据和差距图显示所有纳入的研究。结果将按照坎贝尔合作组织关于证据和差距图开发的建议进行报告。
讨论
迄今为止，支持初级保健中处方使用的计算机化临床决策支持系统背后的证据一直难以综合。证据和差距图代表了一种创新的方法，它已经出现并越来越多地被用于解决更广泛的研究问题，其中可能会评估多种类型的干预措施和结果。考虑到研究设计，我们选择了广泛的纳入标准，以收集所有可用信息。关于局限性，我们将仅包括过去 10 年的英语和西班牙语研究，我们不会进行灰色文献搜索，也不会由于现有研究的可预测异质性而进行荟萃分析。
系统评价注册
本研究在 Open Science Framework 上注册 https://bit.ly/2RqKrWp。
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