Factors That Impact the Adoption of Clinical Decision Support Systems (CDSS) for Antibiotic Management.

Mah Laka,Adriana Milazzo,Tracy Merlin

doi:10.3390/ijerph18041901

Abstract

The study evaluated individual and setting-specific factors that moderate clinicians’ perception regarding use of clinical decision support systems (CDSS) for antibiotic management. A cross-sectional online survey examined clinicians’ perceptions about CDSS implementation for antibiotic management in Australia. Multivariable logistic regression determined the association between drivers of CDSS adoption and different moderators. Clinical experience, CDSS use and care setting were important predictors of clinicians’ perception concerning CDSS adoption. Compared to nonusers, CDSS users were less likely to lack confidence in CDSS (OR = 0.63, 95%, CI = 0.32, 0.94) and consider it a threat to professional autonomy (OR = 0.47, 95%, CI = 0.08, 0.83). Conversely, there was higher likelihood in experienced clinicians (>20 years) to distrust CDSS (OR = 1.58, 95%, CI = 1.08, 2.23) due to fear of comprising their clinical judgement (OR = 1.68, 95%, CI = 1.27, 2.85). In primary care, clinicians were more likely to perceive time constraints (OR = 1.96, 95%, CI = 1.04, 3.70) and patient preference (OR = 1.84, 95%, CI = 1.19, 2.78) as barriers to CDSS adoption for antibiotic prescribing. Our findings provide differentiated understanding of the CDSS implementation landscape by identifying different individual, organisational and system-level factors that influence system adoption. The individual and setting characteristics can help understand the variability in CDSS adoption for antibiotic management in different clinicians.

Highlights

We addressed this gap in knowledge by evaluating the impact of age, gender, clinical experience, care setting and clinical decision support systems (CDSS) availability on users’ intention to adopt CDSS for antibiotic management
We found that young clinicians were more likely to require organisational support in order to adopt CDSS for antibiotic management, perhaps because clinical hierarchy and seniors’ preferences greatly influence the practices of young clinicians [43] and seniors’ in our study were less likely to adopt CDSS
We found that primary care clinicians and those with experience of using CDSS perceived ease of use to be one of the most important features for CDSS adoption

Summary

Introduction

Standardising clinical practice, improving the quality and safety of care and reducing inappropriate prescribing have become priorities for antimicrobial stewardship [2,3]. Clinical decision support systems (CDSS) are a digital health technology that provide clinicians with information at the point-of-care. By connecting evidence-based information on appropriate antibiotic prescribing with patient information, these systems filter and present accurate, real-time information to assist clinical decision making [4,5]. Benefits of CDSS for antibiotic stewardship include optimising the prescribing process by auditing decisions and providing real-time feedback, as well as increasing compliance with antibiotic prescribing guidelines and reducing the risk of unnecessary and inappropriate prescribing of specific antibiotics [6,7]. There is varying evidence available on the efficacy of CDSS for antibiotic management, but some studies have suggested that there can be reductions in the duration of antibiotic therapy, length of hospital stays, cost of antibiotic therapy and in-hospital mortality after the implementation of CDSS [6,8,9,10]

Objectives

Methods

Discussion

Conclusion