Follow-Up Decision Support Tool for Public Healthcare: A Design Research Perspective

IntroductionThe Antidepressant Advisor Study is a feasibility trial of a computerised decision-support tool which uses an algorithm to provide antidepressant treatment guidance for general practitioners (GPs) in the UK primary care service. The tool is the first in the UK to implement national guidelines on antidepressant treatment guidance into a computerised decision-support tool.Methods and analysisThe study is a parallel group, cluster-randomised controlled feasibility trial where participants are blind to treatment allocation. GPs were assigned to two treatment arms: (1) treatment-as-usual (TAU) and (2) computerised decision-support tool to assist with antidepressant choices. The study will assess recruitment and lost to follow-up rates, GP satisfaction with the tool and impact on health service use. A meaningful long-term roll-out unit cost will be calculated for the tool, and service use data will be collected at baseline and follow-up to inform a full economic evaluation of a future trial.Ethics and disseminationThe study has received National Health Service ethical approval from the London—Camberwell St Giles Research Ethics Committee (ref: 17/LO/2074). The trial was pre-registered in the Clinical Trials.gov registry. The results of the study will be published in a pre-publication archive within 1 year of completion of the last follow-up assessment.Trial registration numberNCT03628027.

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Communicating About Mortality in Health Decision Support: ‘What and Why and When, and How and Where and Who’

10.3233/shti210570 ◽

2021 ◽

Author(s):

Jack Dowie ◽

Mette Kjer Kaltoft ◽

Vije Kumar Rajput

Keyword(s):

Decision Support ◽

Decision Support Tool ◽

Evidence Based ◽

Survival Curves ◽

Reasonable Person ◽

Support Tool ◽

Mean Survival Time ◽

Restricted Mean Survival Time ◽

Health Decision

The Covid-19 pandemic has only accelerated the need and desire to deal more openly with mortality, because the effect on survival is central to the comprehensive assessment of harms and benefits needed to meet a ‘reasonable patient’ legal standard. Taking the view that this requirement is best met through a multi-criterial decision support tool, we offer our preferred answers to the questions of What should be communicated about mortality in the tool, and How, given preferred answers to Who for, Who by, Why, When, and Where. Summary measures, including unrestricted Life Expectancy and Restricted Mean Survival Time are found to be reductionist and relative, and not as easy to understand and communicate as often asserted. Full lifetime absolute survival curves should be presented, even if they cannot be ‘evidence-based’ beyond trial follow-up limits, along with equivalent measures for other criteria in the (necessarily) multi-criterial decision. A decision support tool should relieve the reasonable person of the resulting calculation burden.

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The effect of a birthplace decision support tool on women’s decision-making and information gathering behaviours during pregnancy: mybirthplace study protocol

BMJ Health & Care Informatics ◽

10.14236/jhi.v25i1.945 ◽

2018 ◽

Vol 25 (1) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Daisy Wiggins ◽

Vanora A. Hundley ◽

Carol Wilkins ◽

Carol Bond ◽

Gill Walton

Keyword(s):

Decision Making ◽

Decision Support ◽

Mixed Method ◽

Qualitative Interviews ◽

Decision Support Tool ◽

Maternity Hospital ◽

Phase 3 ◽

Support Tool ◽

Accessible Information

BackgroundThe Maternity Review for England highlighted the need for more accessible information to support decisions. This study assesses the effect of a decision support tool (DST) on women’s decision-making regarding birthplace.MethodsA mixed method sequential exploratory design involving three phases and 169 women from a large UK maternity hospital. Phase one: A questionnaire survey pre and post-access to the DST examining knowledge level and stages of decision-making scale. Phase 2: Follow-up questionnaire at 28 weeks to enable the usefulness of Mybirthplace to be evaluated. Phase 3: Qualitative interviews with 10 purposely chosen women at 36 weeks gestation. Collection of data on actual birthplace.DiscussionThis study is the first to assess the effect of a DST in supporting women’s choice of place of birth.

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Opportunities and Barriers for Adoption of a Decision-Support Tool for Alzheimer’s Disease

ACM Transactions on Computing for Healthcare ◽

10.1145/3462764 ◽

2021 ◽

Vol 2 (4) ◽

pp. 1-19

Author(s):

Maura Bellio ◽

Dominic Furniss ◽

Neil P. Oxtoby ◽

Sara Garbarino ◽

Nicholas C. Firth ◽

...

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Decision Support ◽

Design Research ◽

Clinical Care ◽

Decision Support Tool ◽

Added Value ◽

Structured Interviews ◽

Support Tool ◽

Combination Of Methods

Clinical decision-support tools (DSTs) represent a valuable resource in healthcare. However, lack of Human Factors considerations and early design research has often limited their successful adoption. To complement previous technically focused work, we studied adoption opportunities of a future DST built on a predictive model of Alzheimer’s Disease (AD) progression. Our aim is two-fold: exploring adoption opportunities for DSTs in AD clinical care, and testing a novel combination of methods to support this process. We focused on understanding current clinical needs and practices, and the potential for such a tool to be integrated into the setting, prior to its development. Our user-centred approach was based on field observations and semi-structured interviews, analysed through workflow analysis, user profiles, and a design-reality gap model. The first two are common practice, whilst the latter provided added value in highlighting specific adoption needs. We identified the likely early adopters of the tool as being both psychiatrists and neurologists based in research-oriented clinical settings. We defined ten key requirements for the translation and adoption of DSTs for AD around IT, user, and contextual factors. Future works can use and build on these requirements to stand a greater chance to get adopted in the clinical setting.

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Effectiveness of a clinical decision-support tool on adherence to prescribing and practice guidelines of high-risk antidepressant medications in geriatric patients

Mental Health Clinician ◽

10.9740/mhc.2021.05.181 ◽

2021 ◽

Vol 11 (3) ◽

pp. 181-186

Author(s):

Madeline A. VanDaele ◽

Jordan O. Smith ◽

Jessica Bovio Franck

Keyword(s):

Patient Safety ◽

Decision Support ◽

Medication Reconciliation ◽

Geriatric Patients ◽

Decision Support Tool ◽

Clinical Decision ◽

Support Tool ◽

Caregiver Education ◽

Clinical Decision Support Tool

Abstract Introduction TCAs and paroxetine, a SSRI, are associated with safety risks in geriatric patients because of anticholinergic properties. The purpose of this project was to evaluate the impact of a clinical decision-support tool (CDST) on adherence with medication prescribing and practice guidance to enhance patient safety. Methods Mental health clinical pharmacy specialists and clinical pharmacy leadership led a multidisciplinary creation and integration of a CDST within a Veterans Health Administration EHR. The CDST focused on the following elements when prescribing TCAs and paroxetine in geriatric patients: clinical justification for initiation of the medication, provision of patient/caregiver education specific to the medication prescribed, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation. Following activation of the CDST in the EHR, measures were evaluated before intervention and after intervention. Results After intervention, an increase was observed in the primary outcome of the proportion of patients having documentation of all of the following: clinical justification for medication initiation, provision of patient/caregiver education, evaluation of comprehension of education provided, medication reconciliation, and follow-up completed within 30 days of medication initiation (P = .01). Individual proportions of patients with documented medication reconciliation and follow-up completed within 30 days significantly increased. All other secondary outcomes numerically increased but did not reach statistical significance. Discussion Improvement was seen in adherence with prescribing and practice guidance following the implementation of the CDST. This suggests the beneficial role of CDSTs within the EHR to optimize patient safety.

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