TY - JOUR
T1 - Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people
T2 - a European survey
AU - Ploegmakers, Kim J.
AU - Medlock, Stephanie
AU - Linn, Annemiek J.
AU - Lin, Yumin
AU - Seppälä, Lotta J.
AU - Petrovic, Mirko
AU - Topinkova, Eva
AU - Ryg, Jesper
AU - Mora, Maria Angeles Caballero
AU - Landi, Francesco
AU - Thaler, Heinrich
AU - Szczerbińska, Katarzyna
AU - Hartikainen, Sirpa
AU - Bahat, Gulistan
AU - Ilhan, Birkan
AU - Morrissey, Yvonne
AU - the European Geriatric Medicine Society (EuGMS) Task and Finish group on Fall-Risk Increasing Drugs (FRIDs)
AU - Masud, Tahir
AU - van der Velde, Nathalie
AU - van Weert, Julia C. M.
N1 - Funding Information: This work was supported by The Clementine Brigitta Maria Dalderup Fund of the Amsterdam University Fund [grant number 8040] and Aging & Later Life innovation grant, Amsterdam Public Health (APH) [2018]. Publisher Copyright: © 2022, The Author(s), under exclusive licence to European Geriatric Medicine Society.
PY - 2022/4
Y1 - 2022/4
N2 - Purpose: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. Methods: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. Results: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. Conclusion: When designing a CDSS for Geriatric Medicine, the patient’s medical complexity must be addressed whilst maintaining the doctor’s decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.
AB - Purpose: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. Methods: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. Results: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. Conclusion: When designing a CDSS for Geriatric Medicine, the patient’s medical complexity must be addressed whilst maintaining the doctor’s decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.
KW - Barriers
KW - Clinical Decision Support System (CDSS)
KW - Facilitators
KW - Falls prevention
KW - Medication review
UR - http://www.scopus.com/inward/record.url?scp=85123235750&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s41999-021-00599-w
DO - https://doi.org/10.1007/s41999-021-00599-w
M3 - Article
C2 - 35032323
SN - 1878-7649
VL - 13
SP - 395
EP - 405
JO - European Geriatric Medicine
JF - European Geriatric Medicine
IS - 2
ER -