Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey

Ploegmakers, Kim J.; Medlock, Stephanie; Linn, Annemiek J.; Lin, Yu-Min; Seppälä, Lotta J.; Petrovic, Mirko; Topinková, Eva; Ryg, Jesper; Mora, María Ángeles Caballero; Landi, Francesco; Thaler, H; Szczerbińska, Katarzyna; Hartikainen, Sirpa; Bahat, Gülistan; İlhan, Birkan; Morrissey, Yvonne; Masud, Tahir; Velde, Nathalie van der; Weert, Julia C.M. van

doi:10.1007/s41999-021-00599-w

Cited by 13 publications

(16 citation statements)

References 31 publications

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“…Technical issues, having to indicate a reason for overriding an alert and unclear advice were perceived as the most important barriers, as well as time-expenditure of the CDSS, the need of integration with existing systems and accurate advice for medically complex clients. Relevant facilitators were a CDSS that is beneficial to patient care, easy-touse and easily accessible, contributed to increased work efficiency, fits into the physician's workflow and supportive to the decision-making process [52].…”

Section: Discussionmentioning

confidence: 99%

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

et al. 2023

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Introduction:In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries:

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Section: Discussionmentioning

confidence: 99%

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

et al. 2023

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“…In this article, we report in detail the results of the scoping literature review, semi-structured interviews, software development, and usability testing rounds. The results of the systematic literature review, European online survey, modified Delphi study, and development of the fall-risk prediction model are reported in detail elsewhere by the research team [32][33][34][35].…”

Section: Resultsmentioning

confidence: 99%

Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach

Groos,

de Wildt,

van de Loo

et al. 2024

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Introduction: Deprescribing fall-risk increasing drugs (FRIDs) is a promising intervention 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 the use of FRIDs. The ADFICE_IT study addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs through use of a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management. The development process of the CDSS is described in this paper. Methods: 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 scoping and systematic literature review, European survey (n = 581), and semi-structured interviews with physicians (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 end users (n = 11). Results: 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 practice 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. Conclusion: 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 multicenter, cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls.

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“…For those countries formally lacking geriatric medicine as a specialty (Greece and Portugal), hospital-based physicians specializing in care of older patients (and their trainees) were eligible, and are further in this paper referred to as geriatricians. Based on the response rate among European physicians treating older adults in an earlier survey project [ 23 ], and the fact that this would be sufficient to perform sub analyses, we aimed to include approximately 1000 participants from as many European countries as possible. No formal power calculation was performed.…”

Section: Methodsmentioning

confidence: 99%

Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey

et al. 2022

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Purpose To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. Methods An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. Results The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients’ unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. Conclusions Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.

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Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey

Cited by 13 publications

References 31 publications

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

The Implementation of Integrated Health Information Systems – Research Studies from 7 Countries Involving the InterRAI Assessment System

Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach

Deprescribing practices, habits and attitudes of geriatricians and geriatricians-in-training across Europe: a large web-based survey

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