Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
PLoS One. 2024 Sep 5;19(9):e0297703. doi: 10.1371/journal.pone.0297703. eCollection 2024.
Deprescribing fall-risk increasing drugs (FRIDs) is promising for reducing the risk of falling in older adults. Applying appropriate deprescribing in practice can be difficult due to the outcome uncertainties associated with stopping FRIDs. The ADFICE_IT intervention addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs by using a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management.
The development process of the CDSS is described in this paper. Development followed a user-centered design approach in which users and experts were involved throughout each phase. In phase I, a prototype of the CDSS was developed which involved a literature and systematic review, European survey (n = 581), and semi-structured interviews with clinicians (n = 19), as well as the aggregation and testing of deprescribing guidelines and the development of the fall-risk prediction model. In phase II, the feasibility of the CDSS was tested by means of two usability testing rounds with users (n = 11).
The final CDSS consists of five web pages. A connection between the Electronic Health Record allows for the retrieval of patient data into the CDSS. Key design requirements for the CDSS include easy-to-use features for fast-paced clinical environments, actionable deprescribing recommendations, information transparency, and visualization of the patient's fall-risk estimation. Key elements for the software include a modular architecture, open source, and good security.
The ADFICE_IT CDSS supports physicians in deprescribing FRIDs optimally to prevent falls in older patients. Due to continuous user and expert involvement, each new feedback round led to an improved version of the system. Currently, a cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls. The trial is registered with ClinicalTrials.gov (date; 7-7-2022, identifier: NCT05449470).
减少增加跌倒风险的药物（FRIDs）的处方量对于降低老年人跌倒风险很有前景。由于与停止 FRIDs 相关的结果不确定性，在实践中应用适当的减药可能会很困难。ADFICE_IT 干预措施通过使用跌倒风险预测模型、汇总减药指南和联合药物管理的临床决策支持系统（CDSS）来解决这种复杂性。
本文描述了 CDSS 的开发过程。该开发遵循以用户为中心的设计方法，在每个阶段都让用户和专家参与其中。在第一阶段，开发了 CDSS 的原型，涉及文献和系统评价、欧洲调查（n=581）以及与临床医生的半结构化访谈（n=19），以及减药指南的汇总和测试以及跌倒风险预测模型的开发。在第二阶段，通过与用户（n=11）进行两轮可用性测试来测试 CDSS 的可行性。
最终的 CDSS 由五个网页组成。电子健康记录的连接允许将患者数据检索到 CDSS 中。CDSS 的关键设计要求包括适用于快节奏临床环境的易用功能、可操作的减药建议、信息透明度和患者跌倒风险估计的可视化。软件的关键要素包括模块化架构、开源和良好的安全性。
ADFICE_IT CDSS 支持医生优化减少增加跌倒风险的药物（FRIDs）的处方量，以预防老年患者跌倒。由于持续的用户和专家参与，每个新的反馈循环都导致了系统的改进版本。目前，一项在荷兰医院进行的、具有过程评估的、以群组为基础的对照试验正在进行，以测试该 CDSS 对跌倒的影响。该试验已在 ClinicalTrials.gov 注册（日期：2022 年 7 月 7 日，标识符：NCT05449470）。
