PDF(Pubmed)
Abstract：
OBJECTIVE: Electronic health record (EHR) systems are used extensively in healthcare; their design can influence clinicians\' behaviour. We conducted a systematic review of EHR-based interventions aimed at changing the clinical practice of general practitioners in the UK, assessed their effectiveness and applied behaviour change theory to identify lessons for other settings.
METHODS: Mixed methods systematic review.
METHODS: MEDLINE, EMBASE, CENTRAL and APA PsycINFO were searched up to March 2023.
METHODS: Quantitative and qualitative findings from randomised controlled trials (RCTs) controlled before-and-after studies and interrupted time series of EHR-based interventions in UK general practice were included.
METHODS: Quantitative synthesis was based on Cochrane\'s Synthesis without Meta-analysis. Interventions were categorised using the Behaviour Change Wheel and MINDSPACE frameworks and effectiveness determined by vote-counting using direction of effect. Inductive thematic synthesis was used for qualitative studies.
RESULTS: Database searching identified 3824 unique articles; 10 were included (from 2002 to 2021), comprising eight RCTs and two associated qualitative studies. Four of seven quantitative studies showed a positive effect on clinician behaviour and three on patient-level outcomes. Behaviour change techniques that may trigger emotions and required less cognitive engagement appeared to have positive effects. Qualitative findings indicated that interventions reassured clinicians of their decisions but were sometimes ignored.
CONCLUSIONS: Despite widespread use, there is little high quality, up-to-date experimental evidence evaluating the effectiveness of EHR-based interventions in UK general practice. The evidence suggested EHR-based interventions may be effective at changing behaviour. Persistent, simple action-oriented prompts appeared more effective than complex interventions requiring greater cognitive engagement. However, studies lacked detail in intervention design and theory behind design choices. Future research should seek to optimise EHR-based behaviour change intervention design and delineate limitations, providing theory-based justification for interventions. This will be of increasing importance with the growing use of EHRs to influence clinicians\' decisions.
UNASSIGNED: CRD42022341009.
METHODS: Mixed methods systematic review.
METHODS: MEDLINE, EMBASE, CENTRAL and APA PsycINFO were searched up to March 2023.
METHODS: Quantitative and qualitative findings from randomised controlled trials (RCTs) controlled before-and-after studies and interrupted time series of EHR-based interventions in UK general practice were included.
METHODS: Quantitative synthesis was based on Cochrane\'s Synthesis without Meta-analysis. Interventions were categorised using the Behaviour Change Wheel and MINDSPACE frameworks and effectiveness determined by vote-counting using direction of effect. Inductive thematic synthesis was used for qualitative studies.
RESULTS: Database searching identified 3824 unique articles; 10 were included (from 2002 to 2021), comprising eight RCTs and two associated qualitative studies. Four of seven quantitative studies showed a positive effect on clinician behaviour and three on patient-level outcomes. Behaviour change techniques that may trigger emotions and required less cognitive engagement appeared to have positive effects. Qualitative findings indicated that interventions reassured clinicians of their decisions but were sometimes ignored.
CONCLUSIONS: Despite widespread use, there is little high quality, up-to-date experimental evidence evaluating the effectiveness of EHR-based interventions in UK general practice. The evidence suggested EHR-based interventions may be effective at changing behaviour. Persistent, simple action-oriented prompts appeared more effective than complex interventions requiring greater cognitive engagement. However, studies lacked detail in intervention design and theory behind design choices. Future research should seek to optimise EHR-based behaviour change intervention design and delineate limitations, providing theory-based justification for interventions. This will be of increasing importance with the growing use of EHRs to influence clinicians\' decisions.
UNASSIGNED: CRD42022341009.
摘要：
目的：电子健康记录（EHR）系统在医疗保健中广泛使用；它们的设计可以影响临床医生的行为。我们对旨在改变英国全科医生临床实践的基于EHR的干预措施进行了系统评价。评估他们的有效性，并应用行为改变理论来确定其他设置的经验教训。
方法：混合方法系统评价。
方法：MEDLINE，EMBASE,截至2023年3月，搜索了CENTRAL和APAPsycINFO。
方法：包括英国一般实践中基于EHR的干预措施的前后对照研究和中断时间序列的随机对照试验（RCT）的定量和定性结果。
方法：定量合成基于Cochrane的合成，不进行Meta分析。使用行为变化轮和MINDSPACE框架对干预措施进行分类，并通过使用效果方向的投票计数确定有效性。定性研究采用归纳主题合成法。
结果：数据库搜索确定了3824篇独特文章；包括10篇（从2002年到2021年），包括8项随机对照试验和2项相关的定性研究。七项定量研究中有四项对临床医生的行为有积极影响，三项对患者水平的结果有积极影响。可能引发情绪并需要较少的认知参与的行为改变技术似乎具有积极的影响。定性结果表明，干预措施使临床医生放心了他们的决定，但有时被忽略。
结论：尽管广泛使用，没有什么高质量的，最新的实验证据评估在英国一般实践中基于EHR的干预措施的有效性。证据表明，基于EHR的干预措施可能对改变行为有效。持久性,简单的以行动为导向的提示似乎比需要更大认知投入的复杂干预更有效.然而,研究缺乏干预设计和设计选择背后的理论细节。未来的研究应该寻求优化基于EHR的行为改变干预设计，并描述局限性，为干预提供基于理论的理由。随着越来越多地使用EHR来影响临床医生的决策，这将变得越来越重要。
■CRD42022341009。
方法：混合方法系统评价。
方法：MEDLINE，EMBASE,截至2023年3月，搜索了CENTRAL和APAPsycINFO。
方法：包括英国一般实践中基于EHR的干预措施的前后对照研究和中断时间序列的随机对照试验（RCT）的定量和定性结果。
方法：定量合成基于Cochrane的合成，不进行Meta分析。使用行为变化轮和MINDSPACE框架对干预措施进行分类，并通过使用效果方向的投票计数确定有效性。定性研究采用归纳主题合成法。
结果：数据库搜索确定了3824篇独特文章；包括10篇（从2002年到2021年），包括8项随机对照试验和2项相关的定性研究。七项定量研究中有四项对临床医生的行为有积极影响，三项对患者水平的结果有积极影响。可能引发情绪并需要较少的认知参与的行为改变技术似乎具有积极的影响。定性结果表明，干预措施使临床医生放心了他们的决定，但有时被忽略。
结论：尽管广泛使用，没有什么高质量的，最新的实验证据评估在英国一般实践中基于EHR的干预措施的有效性。证据表明，基于EHR的干预措施可能对改变行为有效。持久性,简单的以行动为导向的提示似乎比需要更大认知投入的复杂干预更有效.然而,研究缺乏干预设计和设计选择背后的理论细节。未来的研究应该寻求优化基于EHR的行为改变干预设计，并描述局限性，为干预提供基于理论的理由。随着越来越多地使用EHR来影响临床医生的决策，这将变得越来越重要。
■CRD42022341009。
