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Abstract：
BACKGROUND: Electronic clinical decision support systems (eCDSS), such as the \'Systematic Tool to Reduce Inappropriate Prescribing\' Assistant (STRIPA), have become promising tools for assisting general practitioners (GPs) with conducting medication reviews in older adults. Little is known about how GPs perceive eCDSS-assisted recommendations for pharmacotherapy optimization. The aim of this study was to explore the implementation of a medication review intervention centered around STRIPA in the \'Optimising PharmacoTherapy In the multimorbid elderly in primary CAre\' (OPTICA) trial.
METHODS: We used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs (n = 21) and their patients (n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group (n = 8), and interview data were analyzed through thematic analysis.
RESULTS: In quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations.
CONCLUSIONS: Qualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs\' overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports).
BACKGROUND: Clinicaltrials.gov NCT03724539, date of first registration: 29/10/2018.
METHODS: We used an explanatory mixed methods design combining quantitative and qualitative data. First, quantitative data about the acceptance and implementation of eCDSS-generated recommendations from GPs (n = 21) and their patients (n = 160) in the OPTICA intervention group were collected. Then, semi-structured qualitative interviews were conducted with GPs from the OPTICA intervention group (n = 8), and interview data were analyzed through thematic analysis.
RESULTS: In quantitative findings, GPs reported averages of 13 min spent per patient preparing the eCDSS, 10 min performing medication reviews, and 5 min discussing prescribing recommendations with patients. On average, out of the mean generated 3.7 recommendations (SD=1.8). One recommendation to stop or start a medication was reported to be implemented per patient in the intervention group (SD=1.2). Overall, GPs found the STRIPA useful and acceptable. They particularly appreciated its ability to generate recommendations based on large amounts of patient information. During qualitative interviews, GPs reported the main reasons for limited implementation of STRIPA were related to problems with data sourcing (e.g., incomplete data imports), preparation of the eCDSS (e.g., time expenditure for updating and adapting information), its functionality (e.g., technical problems downloading PDF recommendation reports), and appropriateness of recommendations.
CONCLUSIONS: Qualitative findings help explain the relatively low implementation of recommendations demonstrated by quantitative findings, but also show GPs\' overall acceptance of STRIPA. Our results provide crucial insights for adapting STRIPA to make it more suitable for regular use in future primary care settings (e.g., necessity to improve data imports).
BACKGROUND: Clinicaltrials.gov NCT03724539, date of first registration: 29/10/2018.
摘要：
背景：电子临床决策支持系统（eCDSS），例如“减少不适当处方的系统工具”助理(STRIPA)，已成为有希望的工具，用于协助全科医生（GP）在老年人中进行药物审查。关于全科医生如何看待eCDSS辅助的药物治疗优化建议知之甚少。这项研究的目的是探索在“优化药物疗法”（OPTICA）试验中，以STRIPA为中心的药物审查干预措施的实施。
方法：我们使用了结合定量和定性数据的解释性混合方法设计。首先,收集了OPTICA干预组的全科医生(n=21)及其患者(n=160)接受和实施eCDSS产生的建议的定量数据.然后，对OPTICA干预组的全科医生进行了半结构化定性访谈(n=8)，和访谈数据通过主题分析进行分析。
结果：在定量结果中，全科医生报告每位患者平均花费13分钟准备eCDSS，10分钟进行药物审查，5分钟与患者讨论处方建议。平均而言,在平均值之外，产生了3.7条建议(SD=1.8)。据报道，干预组中每位患者实施了一项停止或开始用药的建议（SD=1.2）。总的来说,GP发现STRIPA有用且可接受。他们特别赞赏其基于大量患者信息生成建议的能力。在定性访谈中，全科医生报告说，STRIPA实施有限的主要原因与数据来源问题有关(例如，不完整的数据导入)，eCDSS的准备(例如，更新和调整信息的时间支出)，其功能(例如，技术问题下载PDF推荐报告)，以及建议的适当性。
结论：定性结果有助于解释定量结果所显示的建议执行率相对较低的情况，同时也显示了全科医生对STRIPA的总体接受度。我们的结果为调整STRIPA提供了重要的见解，使其更适合在未来的初级保健环境中定期使用(例如，改善数据导入的必要性)。
背景：Clinicaltrials.govNCT03724539，首次注册日期：2018年10月29日。
方法：我们使用了结合定量和定性数据的解释性混合方法设计。首先,收集了OPTICA干预组的全科医生(n=21)及其患者(n=160)接受和实施eCDSS产生的建议的定量数据.然后，对OPTICA干预组的全科医生进行了半结构化定性访谈(n=8)，和访谈数据通过主题分析进行分析。
结果：在定量结果中，全科医生报告每位患者平均花费13分钟准备eCDSS，10分钟进行药物审查，5分钟与患者讨论处方建议。平均而言,在平均值之外，产生了3.7条建议(SD=1.8)。据报道，干预组中每位患者实施了一项停止或开始用药的建议（SD=1.2）。总的来说,GP发现STRIPA有用且可接受。他们特别赞赏其基于大量患者信息生成建议的能力。在定性访谈中，全科医生报告说，STRIPA实施有限的主要原因与数据来源问题有关(例如，不完整的数据导入)，eCDSS的准备(例如，更新和调整信息的时间支出)，其功能(例如，技术问题下载PDF推荐报告)，以及建议的适当性。
结论：定性结果有助于解释定量结果所显示的建议执行率相对较低的情况，同时也显示了全科医生对STRIPA的总体接受度。我们的结果为调整STRIPA提供了重要的见解，使其更适合在未来的初级保健环境中定期使用(例如，改善数据导入的必要性)。
背景：Clinicaltrials.govNCT03724539，首次注册日期：2018年10月29日。
