Clinical Decision Support to Promote Safe Prescribing to Women of Reproductive Age: A Cluster-Randomized Trial

Abstract Background Computerized Clinical Decision Support Systems (CCDSS) are information technology tools, designed to improve clinical decision-making. Telemedicine is a health care service delivery using videoconferencing, telephone or messaging technologies. Objectives Our project aimed at testing the effectiveness of a composite CCDSS and telemedicine approach designed to treat depression in primary care. Methods This cluster randomized trial involved four GP clinics located in Northern Italy. Two clinics were assigned to the experimental protocol, and two served as controls. The study compared the telemedicine group (TG), in which GPs had access to a CCDSS platform, with the control group (CG) in which GPs provided treatment as usual (TAU). Patients scoring ≥11 on Patient Heath Questionnaire and ≥26 on the Inventory of Depressive Symptomatology-Self-Report were eligible for participation. Patients were also administered the World Health Organization Quality of Life-BREF to assess quality of life and Medical Interview Satisfaction Scale 21 to assess satisfaction with the medical interview. Results Overall, 2810 patients were screened and 66 in the experimental group and 32 in the CG passed the screening stages and met inclusion criteria. The percentage of remitters at 6 months was significantly higher in the TG than in the CG group (24.1% versus 3.1%, χ 2 = 6.6, P = 0.01). This difference remained significant after adjusting for baseline confounders. Physical and psychological quality of life improved significantly from baseline in both groups. Patients reported, on average, good satisfaction with the medical interview. Conclusions Our study showed that a combined CCDSS and telemedicine approach may be more effective than the TAU offered by GPs to patients with depression. Trial registration The trial was registered on https://clinicaltrials.gov/ on 5 October 2012 with identifier: NCT01701791. The first participant was enrolled on 5 May 2014 and the study was completed on May 2016.

Download Full-text

The effect of a clinical decision support system on prompting an intervention for risky alcohol use in a primary care smoking cessation program: a cluster randomized trial

Implementation Science ◽

10.1186/s13012-019-0935-x ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 4

Author(s):

Nadia Minian ◽

Dolly Baliunas ◽

Aliya Noormohamed ◽

Laurie Zawertailo ◽

Norman Giesbrecht ◽

...

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Decision Support ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Cluster Randomized Trial ◽

Clinical Decision ◽

Risky Alcohol ◽

Cluster Randomized

Download Full-text

Best Paper Selection

Yearbook of Medical Informatics ◽

10.1055/s-0041-1726535 ◽

2021 ◽

Vol 30 (01) ◽

pp. 175-175

Keyword(s):

General Practice ◽

Decision Support ◽

Multicentre Study ◽

Hospital Admission ◽

Clinical Decision Support ◽

Clinical Decision Support System ◽

Clinical Decision Support Systems ◽

Cluster Randomized Trial ◽

Clinical Decision ◽

Cluster Randomized

Wu G, Yang P, Xie Y, Woodruff HC, Rao X, Guiot J, Frix AN, Louis R, Moutschen M, Li J, Li J, Yan C, Du D, Zhao S, Ding Y, Liu B, Sun W, Albarello F, D’Abramo A, Schininà V, Nicastri E, Occhipinti M, Barisione G, Barisione E, Halilaj I, Lovinfosse P, Wang X, Wu J, Lambin P. Development of a clinical decision support system for severity risk prediction and triage of COVID-19 patients at hospital admission: an international multicentre study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7331655/ Balestrieri M, Sisti D, Rocchi M, Rucci P, Simon G, Araya R, de Girolamo G. Effectiveness of clinical decision support systems and telemedicine on outcomes of depression: a cluster randomized trial in general practice. https://academic.oup.com/fampra/article/37/6/731/5882119

Download Full-text

Computerized Clinical Decision Support System for Prompting Brief Alcohol Interventions with Treatment Seeking Smokers: A Sex-Based Secondary Analysis of a Cluster Randomized Trial

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17031024 ◽

2020 ◽

Vol 17 (3) ◽

pp. 1024 ◽

Cited By ~ 1

Author(s):

Nadia Minian ◽

Anna Ivanova ◽

Sabrina Voci ◽

Scott Veldhuizen ◽

Laurie Zawertailo ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Support System ◽

Clinical Decision Support System ◽

Secondary Analysis ◽

Cluster Randomized Trial ◽

Clinical Decision ◽

Alcohol Intervention ◽

Brief Alcohol Intervention ◽

Cluster Randomized

Although brief alcohol intervention can reduce alcohol use for both men and women, health care providers (HCPs) are less likely to discuss alcohol use or deliver brief intervention to women compared to men. This secondary analysis examined whether previously reported outcomes from a cluster randomized trial of a clinical decision support system (CDSS)—prompting delivery of a brief alcohol intervention (an educational alcohol resource) for patients drinking above cancer guidelines—were moderated by patients’ sex. Patients (n = 5702) enrolled in a smoking cessation program at primary care sites across Ontario, Canada, were randomized to either the intervention (CDSS) or control arm (no CDSS). Logistic generalized estimating equations models were fit for the primary and secondary outcome (HCP offer of resource and patient acceptance of resource, respectively). Previously reported results showed no difference between treatment arms in HCP offers of an educational alcohol resource to eligible patients, but there was increased acceptance of the alcohol resource among patients in the intervention arm. The results of this study showed that these CDSS intervention effects were not moderated by sex, and this can help inform the development of a scalable strategy to overcome gender disparities in alcohol intervention seen in other studies.

Download Full-text

Assessing preconception nutrition readiness among women of reproductive age in Bantul, Indonesia: findings from baseline data analysis of a cluster randomized trial

Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics) ◽

10.21927/ijnd.2020.8(2).68-79 ◽

2021 ◽

Vol 8 (2) ◽

pp. 68

Author(s):

Yhona Paratmanitya ◽

Siti Helmyati ◽

Detty S Nurdiati ◽

Emma C Lewis ◽

Hamam Hadi

Keyword(s):

Body Mass Index ◽

Folic Acid ◽

Dietary Intake ◽

Randomized Trial ◽

Body Mass ◽

Iron Status ◽

Cluster Randomized Trial ◽

Reproductive Age ◽

Women Of Reproductive Age ◽

Cluster Randomized

ABSTRAK Latar Belakang: Pemenuhan gizi pada masa prakonsepsi merupakan hal yang penting untuk memastikan kehamilan yang sehat, namun banyak wanita di negara-negara berkembang yang belum menyadari pentingnya hal tersebut. Informasi tentang kesiapan gizi prakonsepsi pada wanita usia subur, khususnya di negara berkembang, masih terbatas.Tujuan: Untuk mengetahui kesiapan gizi prakonsepsi pada calon pengantin wanita di IndonesiaMetode: Penelitian ini merupakan bagian dari studi cluster randomized trial untuk meningkatkan status besi ibu hamil di Kabupaten Bantul, Yogyakarta, yang melibatkan 173 calon pengantin wanita. Data antropometri, asupan makan, dan pengetahuan tentang gizi prakonsepsi dikumpulkan oleh enumerator yang terlatih, yaitu mahasiswa di Fakultas Kesehatan, Universitas Alma Ata, dengan melakukan kunjungan ke rumah responden. Data kadar Hemoglobin (Hb) diperoleh melalui kuesioner. Kesiapan gizi prakonsepsi diukur menggunakan 10 indikator, yang meliput: (1) Indeks Massa Tubuh (IMT); (2) Lingkar Lengan Atas (LILA); (3) kadar Hb; (4) asupan energi; (5) asupan protein; (6) asupan kalsium; (7) asupan zat besi; (8) asupan folat; (9) pengetahuan tentang gizi prakonsepsi; dan (10) konsumsi suplemen zat besi dan/atau asam folat. Skor kesiapan akan berkisar antara 0-10.Hasil: Tidak ada satupun responden yang dapat memenuhi seluruh indikator kesiapan gizi prakonsepsi. Sebanyak 26% responden dapat memenuhi 2 indikator, dan median skor-nya adalah 3 (2.0-4.0). Kadar Hb, IMT, dan LILA merupakan 3 indikator terbanyak yang dapat dipenuhi, sementara asupan kalsium, zat besi, dan folat merupakan 3 indikator yang paling sedikit dapat dipenuhi oleh responden.Kesimpulan: Peningkatan kesadaran akan pentingnya mempersiapkan gizi prakonsepsi pada calon ibu merupakan hal yang sangat diperlukan. Program intervensi gizi kedepannya sebaiknya sudah dimulai sejak masa prakonsepsi, bukan hanya fokus pada kehamilan. KATA KUNCI: Indeks Massa Tubuh; asupan makan; prakonsepsi; wanita usia subur ABSTRACTBackground: Proper nutrition during preconception is essential to ensuring a healthy pregnancy, however, women in developing countries may not be aware of its importance. Information is limited regarding nutrition readiness prior to conception among women of reproductive age in these settings.Objectives: To examine nutrition readiness prior to conception among premarital women living in Indonesia.Methods: This study was part of a cluster randomized trial which aimed to improve the iron status of pregnant women in Bantul District, Yogyakarta, Indonesia. A total of 173 premarital women were included in the study. Data were collected on anthropometry, dietary intake, and knowledge about preconception nutrition by trained nutrition students of the University of Alma Ata, and taking place in the participant’s home. Hemoglobin level data were obtained based on answers to a questionnaire. Preconception nutrition readiness for pregnancy was determined based on 10 indicators, including: (1) body mass index (BMI); (2) mid-upper arm circumference (MUAC); (3) hemoglobin (Hb) level; average daily intakes for (4) energy, (5) protein, (6) calcium, (7) iron, and (8) folic acid; (9) level of knowledge about preconception nutrition; and (10) folic acid and/or iron supplement consumption. Preconception nutrition readiness scores ranged from 0-10.Results: No study participants met all 10 indicators for preconception nutrition readiness. One-quarter (26.0%) of participants could only meet 2 indicators, and the median score was 3.0 (2.0-4.0). Hb level, BMI, and MUAC were the 3 indicators met most by participants, while iron, folic acid, and calcium intake were the least met indicators.Conclusion: Raising awareness about preconception nutritional preparation among women of reproductive age is urgent. Future nutrition intervention programs should target the preconception period. KEYWORDS: Body mass index; dietary intake; preconception; women of reproductive age.

Download Full-text