Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool

Melissa T Baysari,Mai H Duong,Sarah N Hilmer,Selvana Awad,Michaela Stockey-Bridge,Wu Yi Zheng,Patrick Hooper

doi:10.1186/s12911-021-01484-z

Abstract

BackgroundDespite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice.MethodsOur CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient’s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists.ResultsParticipants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback.ConclusionUsability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care.

Highlights

Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, in hospital settings
We report results related to only one component of our computerised decision support (CDS) tool, a Drug Burden Index (DBI) MPage
Usability issues identified during Round 1 testing Participants expressed positive views about several components of the DBI MPage

Summary

Introduction

Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, in hospital settings. A recent study comprising interviews with geriatricians and pharmacists across four UK hospitals, identified a number of barriers to deprescribing in this context [5] These included barriers related to professional roles (i.e. perceived scope of practice, lack of confidence), to the inpatient environment (i.e. limited information, acute nature of admission), and to attitudes and beliefs (e.g. attitudes towards medications, beliefs about risks) [5]. These barriers are consistent with those identified in a study conducted across six Australian hospitals, where many healthcare professionals did not consider deprescribing to be their responsibility, felt insecure and uncertain about deprescribing, and reported that it did not fit with the timeframe and workflow of an acute admission [6]

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