Abstract
BackgroundClinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. This study examined if the addition of a CDSS influenced practitioner delivery of a brief intervention with treatment-seeking smokers who were drinking above recommended alcohol consumption guidelines, compared with practitioners who do not receive a CDSS prompt.MethodsThis was a cluster randomized controlled trial conducted in primary health care clinics across Ontario, Canada, implementing the Smoking Treatment for Ontario Patients (STOP) smoking cessation program. Clinics randomized to the intervention group received a prompt when a patient reported consuming alcohol above the Canadian Cancer Society (CCS) guidelines; the control group did not receive computer alerts. The primary outcome was an offer of an appropriate educational alcohol resource, an alcohol reduction workbook for patients drinking above the CCS guidelines, and an abstinence workbook to patients scoring above 20 points in the AUDIT screening tool; the secondary outcome was patient acceptance of the resource. The tertiary outcome was patient abstinence from smoking, and alcohol consumption within CCS guidelines, at 6-month follow-up. Results were analyzed using a generalized estimation approach for fitting logistic regression using a population-averaged method.ResultsTwo hundred and twenty-one clinics across Ontario were randomized for this study; 110 to the intervention arm and 111 to the control arm. From the 15,222 patients that enrolled in the smoking cessation program, 15,150 (99.6% of patients) were screened for alcohol use and 5715 patients were identified as drinking above the CCS guidelines. No statistically significant difference between groups was seen in practitioner offer of an educational alcohol resource to appropriate patients (OR = 1.19, 95% CI 0.88–1.64, p = 0.261) or in patient abstinence from smoking and drinking within the CCS guidelines at 6-month follow-up (OR = 0.93, 95% CI 0.71–1.22, p = 0.594). However, a significantly greater proportion of patients in the intervention group accepted the alcohol resource offered to them by their practitioner (OR = 1.48, 95% CI 1.01–2.16, p = 0.045).ConclusionA CDSS may not increase the likelihood of practitioners offering an educational alcohol resource, though it may have influenced patients’ acceptance of the resource.Trial registrationThis trial is registered with ClinicalTrials.gov, number NCT03108144, registered on April 11, 2017, “retrospectively registered”.
Highlights
Clinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines
We examined if a CDSS would facilitate practitioners to deliver a brief alcohol intervention and an appropriate alcohol resource, an alcohol reduction workbook to their Smoking Treatment for Ontario Patients (STOP) patients drinking above the Canadian Cancer Society (CCS) guidelines but below the Alcohol Use Disorders Identification Test (AUDIT) cutoff of 20 points, and alcohol abstinence resource to patients scoring above the AUDIT cutoff of 20 points
Of the 222 practices (148 Family health team (FHT), 57 Community health centers (CHC), and 17 nurse practitioner-led clinics (NPLCs)) that were assessed for eligibility, one practice was excluded because it was not using the STOP online portal
Summary
Clinical decision support systems (CDSSs) may promote practitioner adherence to evidence-based guidelines. Implementation science is focused on understanding and accelerating the integration of research findings and research-based innovation into everyday practice settings to improve health. This is critical given the substantial barriers between evidence-based knowledge and practice across all health care disciplines [1]. Non-adherence of practitioners to practice guidelines is common; there are intensive efforts by administrators and quality improvement specialists to promote evidencebased decision-making in a range of clinical settings [2]. Cancer risk due to dual tobacco and alcohol consumption can potentially be minimized by following recommended guidelines to provide screening, brief interventions, and referrals to treatment (SBIRT) to eligible patients in a primary care setting
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