Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals.
Antimicrobial guidelines
Antimicrobial stewardship
Computerised decision support system
Medical informatics
Qualitative methodology
Semi-structured interview
Journal
International journal of medical informatics
ISSN: 1872-8243
Titre abrégé: Int J Med Inform
Pays: Ireland
ID NLM: 9711057
Informations de publication
Date de publication:
09 2020
09 2020
Historique:
received:
30
01
2020
revised:
07
05
2020
accepted:
08
07
2020
pubmed:
1
8
2020
medline:
22
12
2020
entrez:
1
8
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32736330
pii: S1386-5056(20)30127-1
doi: 10.1016/j.ijmedinf.2020.104233
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Anti-Infective Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
104233Informations de copyright
Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.