scholarly journals Electronic clinical decision support tool for assessing stomach symptoms in primary care (ECASS): a feasibility study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e041795
Author(s):  
Greg Rubin ◽  
Fiona M Walter ◽  
Jon Emery ◽  
Willie Hamilton ◽  
Zoe Hoare ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Feasibility Study ◽  
Clinical Decision Support ◽  
Controlled Trial ◽  
Health Economic Evaluation ◽  
Clinical Decision ◽  
Clinical Workflow ◽  
Definitive Trial ◽  
Electronic Clinical Decision Support

ObjectiveTo determine the feasibility of a definitive trial in primary care of electronic clinical decision support (eCDS) for possible oesophago-gastric (O-G) cancer.Design and settingFeasibility study in 42 general practices in two regions of England, cluster randomised controlled trial design without blinding, nested qualitative and health economic evaluation.ParticipantsPatients aged 55 years or older, presenting to their general practitioner (GP) with symptoms associated with O-G cancer. 530 patients (mean age 68 years, 58% female) participated.InterventionPractices randomised 1:1 to usual care (control) or to receive a previously piloted eCDS tool for suspected cancer (intervention), for use at the discretion of the GPs, supported by a theory-based implementation package and ongoing support. We conducted semistructured interviews with GPs in intervention practices. Recruitment lasted 22 months.OutcomesPatient participation rate, use of eCDS, referrals and route to diagnosis, O-G cancer diagnoses; acceptability to GPs; cost-effectiveness. Participants followed up 6 months after index encounter.ResultsFrom control and intervention practices, we screened 3841 and 1303 patients, respectively; 1189 and 434 were eligible, 392 and 138 consented to participate. Ten patients (1.9%) had O-G cancer. eCDS was used eight times in total by five unique users. GPs experienced interoperability problems between the eCDS tool and their clinical system and also found it did not fit with their workflow. Unexpected restrictions on software installation caused major problems with implementation.ConclusionsThe conduct of this study was hampered by technical limitations not evident during an earlier pilot of the eCDS tool, and by regulatory controls on software installation introduced by primary care trusts early in the study. This eCDS tool needed to integrate better with clinical workflow; even then, its use for suspected cancer may be infrequent. Any definitive trial of eCDS for cancer diagnosis should only proceed after addressing these constraints.Trial registration numberISRCTN125595588.

scholarly journals Introducing pharmacogenetic testing with clinical decision support into primary care: a feasibility study

CMAJ Open ◽  
2016 ◽  
Vol 4 (3) ◽  
pp. E528-E534 ◽  
Author(s):  
Martin Dawes ◽  
Martin N. Aloise ◽  
J. Sidney Ang ◽  
Pieter Cullis ◽  
Diana Dawes ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Feasibility Study ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Pharmacogenetic Testing

scholarly journals LO73: A randomized controlled trial of electronic clinical decision support to reduce unnecessary CT imaging for patients with suspected pulmonary embolism

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S32-S33
Author(s):  
J.E. Andruchow ◽  
D. Grigat ◽  
A.D. McRae ◽  
T. Abedin ◽  
D. Wang ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Controlled Trial ◽  
Clinical Decision ◽  
Evidence Based ◽  
Index Visit ◽  
Randomized Controlled ◽  
Electronic Clinical Decision Support

Introduction: Utilization of CT pulmonary angiography (CTPA) to rule out pulmonary embolism (PE) has risen dramatically but diagnostic yield has fallen over the past several decades, suggesting that lower risk patients are being tested. Given little evidence to suggest improved patient outcomes with higher CTPA utilization, and increasing evidence of harm, evidence-based guidelines have been developed to reduce unnecessary CTPA use. The objective of this study was to assess the impact of an electronic clinical decision support (CDS) intervention to reduce unnecessary CTPA utilization for emergency department (ED) patients with suspected PE. Methods: This was a cluster-randomized, controlled trial with physicians as the unit of randomization. All emergency physicians (EPs) at 4 urban adult EDs and 1 urgent care center were randomly assigned to receive either evidence-based imaging CDS for patients with suspected PE (intervention) or no CDS (control) over a 1-year study period. CDS was launched in an external web browser whenever an intervention EP ordered a CTPA from the computerized physician order entry software for ED patients CTAS 2-5; however, physician interaction with CDS was voluntary. The CDS tool enabled calculation of patient-specific information, including the patients Wells score, PERC score, and age-adjusted D-dimer, as well as prediction of each patients pre-test risk of PE along with an imaging/no imaging recommendation. CDS recommendations could be printed for the medical record as could educational patient handouts to support physician decision-making. The primary outcome was CTPA utilization for patients with CEDIS chief complaints of shortness of breath or chest pain on the index visit. Secondary outcomes included index visit length of stay (LOS), and CTPA use or VTE diagnosis within 90-days. This study was REB approved. Results: Demographics were similar among intervention and control EPs; however, during a 2-year pre-intervention period control EPs had a higher baseline CTPA rate (8.5% vs 7.7%, p<0.001). In the first 8-months following CDS implementation, 94 intervention EPs saw 9,609 patients and voluntarily interacted with the CDS tool on 43.2% of eligible encounters while 91 control EPs saw 9,498 patients. CTPA utilization was higher among intervention EPs than control (9.6% vs 8.3%, p<0.001) as was ED LOS (302 vs 287 minutes, p<0.001). There was no difference in 90-day CTPA use or VTE diagnoses. Conclusion: In one of the largest RCTs of CDS to date, exposure to CDS was associated with higher rates of CTPA utilization and longer ED LOS on the index visit, and no difference in 90-day CT use or VTE diagnoses. These results differ from a concurrent study of CDS for patients with mild traumatic brain injury in the same physician population and may relate to the implementation of the CDS intervention and/or complexity of the underlying evidence-based algorithms.

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