当前位置: X-MOL 学术Int. J. Med. Inform. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals.
International Journal of Medical Informatics ( IF 4.9 ) Pub Date : 2020-07-13 , DOI: 10.1016/j.ijmedinf.2020.104233
Gaud Catho 1 , Nicolò Saverio Centemero 2 , Heloïse Catho 3 , Alice Ranzani 1 , Carlo Balmelli 4 , Caroline Landelle 5 , Veronica Zanichelli 6 , Benedikt David Huttner 1 ,
Affiliation  

Background and Objectives

Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use and reduce inappropriate prescriptions through a panel of interventions. The implementation of clinical guidelines is a core strategy of AMS programs. Nevertheless, their dissemination and application remain low. Computerised decision support systems (CDSSs) offer new opportunities for semi-automated dissemination of guidelines. This qualitative study aimed at gaining an in-depth understanding of the determinants of adherence to antimicrobial prescribing guidelines and CDSSs adoption and is part of a larger project, the COMPASS trial, which aims to assess a CDSS for antimicrobial prescription. The final objective of this qualitative study is to 1) provide insights from end-users to assist in the design of the COMPASS CDSS, and to 2) help with the interpretation of the quantitative findings of the randomised controlled trial assessing the COMPASS CDSS, once data will be analysed.

Methods

We conducted semi-structured individual interviews among in-hospital physicians in two hospitals in Switzerland and one hospital in France. Physicians were recruited by convenience sampling and snowballing until data saturation was achieved.

Results

Twenty-nine physicians were interviewed. We identified three themes related to the potential barriers to guideline adherence: 1) insufficient clarity, accessibility and applicability of guidelines, 2) need of critical thinking skills to adhere to guidelines and 3) impact of the team prescribing process and peers on physicians in training. As to the perception of CDSSs, we identified four themes that could affect their adoption: 1) CDSSs are perceived as time-consuming, 2) CDSSs could reduce physicians’ critical thinking and professional autonomy and raise new medico-legal issues, 3) effective CDSSs would require specific features, such as ease of use and speed, which affect usability and 4) CDSSs could improve physicians’ adherence to guidelines and patient care.

Discussion

CDSSs have the potential to overcome several barriers for adherence to guidelines by improving accessibility and providing individualised recommendations backed by patient data. When designing CDSSs, mixed clinical and information technology teams should focus on user-friendliness, ergonomics, workflow integration and transparency of the decision-making process.



中文翻译:

决定是否遵守抗菌药物指南以及医生采用计算机决策支持系统的因素:在三家欧洲医院进行的定性研究。

背景和目标

抗菌管理(AMS)计划旨在通过一系列干预措施来优化抗生素的使用并减少不适当的处方。临床指南的实施是AMS计划的核心策略。然而,它们的传播和应用仍然很少。计算机化的决策支持系统(CDSS)为准自动发布准则提供了新的机会。这项定性研究旨在深入了解遵守抗菌药物处方指南和采用CDSS的决定因素,并且是COMPASS试验这一较大项目的一部分,该试验旨在评估CDSS用于抗菌药物处方。这项定性研究的最终目标是:1)提供最终用户的见解,以协助COMPASS CDSS的设计,

方法

我们在瑞士的两家医院和法国的一家医院对住院医生进行了半结构化的个人访谈。通过便利采样和滚雪球招募医师,直到数据饱和为止。

结果

采访了29位医师。我们确定了与遵循准则的潜在障碍相关的三个主题:1)准则的清晰度,可及性和适用性不足; 2)需要批判性思维技能来遵守准则; 3)团队处方过程和同行对培训医师的影响。关于CDSS的认知,我们确定了四个可能影响其采用的主题:1)CDSS被认为很耗时; 2)CDSS可以减少医师的批判性思维和专业自主权,并提出新的法医学问题; 3)有效CDSS将需要特定的功能,例如易用性和速度,这会影响可用性。4)CDSS可以提高医师对指南和患者护理的依从性。

讨论区

CDSS通过改善可访问性并提供患者数据支持的个性化建议,有可能克服遵守准则的若干障碍。在设计CDSS时,混合的临床和信息技术团队应将重点放在用户友好性,人体工程学,工作流程集成和决策过程的透明性上。

更新日期:2020-07-29
down
wechat
bug