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. 2019 Sep;25(3):1076-1090.
doi: 10.1177/1460458217740407. Epub 2017 Nov 17.

For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners

Stephanie Medlock  1 , Saeid Eslami  2 , Marjan Askari  3 , Derk L Arts  4 , Esther M van de Glind  1 , Henk J Brouwer, Henk C van Weert  5 , Sophia E de Rooij  6 , Ameen Abu-Hanna  1
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For which clinical rules do doctors want decision support, and why? A survey of Dutch general practitioners

Stephanie Medlock et al. Health Informatics J. 2019 Sep.

Abstract

Despite the promise of decision support for improving care, alerts are often overridden or ignored. We evaluated Dutch general practitioners' intention to accept decision support in a proposed implementation based on clinical rules regarding care for elderly patients, and their reasons for wanting or not wanting support. We developed a survey based on literature and structured interviews and distributed it to all doctors who would receive support in the proposed implementation (n = 43), of which 65 percent responded. The survey consisted of six questions for each of 20 clinical rules. Despite concerns about interruption, doctors tended to choose more interruptive forms of support. Doctors wanted support when they felt the rule represented minimal care, perceived a need to improve care, and felt responsible for the action and that they might forget to perform the action; doctors declined support due to feeling that it was unnecessary and due to concerns about interruption.

Keywords: clinical; decision support systems; general practitioners; medication alert systems; surveys.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Survey development and deployment process. The survey was developed based on input from the literature and interviews with clinicians and experts in decision support. The content was validated by conducting a second set of interviews, including a concurrent “think-aloud” process. The final survey was deployed online.
Figure 2.
Figure 2.
Histogram of responses to the question, “This rule is followed in practice in __% of cases” for rules where support was wanted (left, n = 229) and declined (right, n = 140). The x-axis represents the response categories (0%, 10%, 20%, …, 100%) and the y-axis represents the percentage of responses in that category. Respondents tended to want support for rules when they estimated current compliance to be in the high-middle range and decline support when they estimated current compliance to be low or very high.
Figure 3.
Figure 3.
Frequency of selection of reasons for wanting or declining support. Respondents could choose any number of reasons, no reasons, or fill in a free-text field (“other”). Percentages are the percentage of responses which included this item. The full text of the reasons is given in Tables 3 and 4.
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