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Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people : a European survey

Kim J. Ploegmakers, Stephanie Medlock, Annemiek J. Linn, Yumin Lin, Lotta J. Seppälä, Mirko Petrovic (UGent) , Eva Topinkova, Jesper Ryg, Maria Angeles Caballero Mora, Francesco Landi, et al.
(2022) EUROPEAN GERIATRIC MEDICINE. 13. p.395-405
Author
Organization
Abstract
Purpose Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. Methods We examined and compared the relative importance and the occurrence of regional differences of a literature based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. Results We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. Conclusion When designing a CDSS for Geriatric Medicine, the patient’s medical complexity must be addressed whilst maintaining the doctor’s decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.
Keywords
Clinical Decision Support System (CDSS), barriers, facilitators, medication review, falls prevention, EVIDENCE-BASED MEDICINE, INCREASING DRUGS, PRESCRIPTION, ACCEPTANCE, TRIALS, ALERTS

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MLA
Ploegmakers, Kim J., et al. “Barriers and Facilitators in Using a Clinical Decision Support System for Fall Risk Management for Older People : A European Survey.” EUROPEAN GERIATRIC MEDICINE, vol. 13, 2022, pp. 395–405, doi:10.1007/s41999-021-00599-w.
APA
Ploegmakers, K. J., Medlock, S., Linn, A. J., Lin, Y., Seppälä, L. J., Petrovic, M., … van Weert, J. C. M. (2022). Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people : a European survey. EUROPEAN GERIATRIC MEDICINE, 13, 395–405. https://doi.org/10.1007/s41999-021-00599-w
Chicago author-date
Ploegmakers, Kim J., Stephanie Medlock, Annemiek J. Linn, Yumin Lin, Lotta J. Seppälä, Mirko Petrovic, Eva Topinkova, et al. 2022. “Barriers and Facilitators in Using a Clinical Decision Support System for Fall Risk Management for Older People : A European Survey.” EUROPEAN GERIATRIC MEDICINE 13: 395–405. https://doi.org/10.1007/s41999-021-00599-w.
Chicago author-date (all authors)
Ploegmakers, Kim J., Stephanie Medlock, Annemiek J. Linn, Yumin Lin, Lotta J. Seppälä, Mirko Petrovic, Eva Topinkova, Jesper Ryg, Maria Angeles Caballero Mora, Francesco Landi, Heinrich Thaler, Katarzyna Szczerbińska, Sirpa Hartikainen, Gulistan Bahat, Birkan Ilhan, Yvonne Morrissey, Tahir Masud, Nathalie van der Velde, and Julia C. M. van Weert. 2022. “Barriers and Facilitators in Using a Clinical Decision Support System for Fall Risk Management for Older People : A European Survey.” EUROPEAN GERIATRIC MEDICINE 13: 395–405. doi:10.1007/s41999-021-00599-w.
Vancouver
1.
Ploegmakers KJ, Medlock S, Linn AJ, Lin Y, Seppälä LJ, Petrovic M, et al. Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people : a European survey. EUROPEAN GERIATRIC MEDICINE. 2022;13:395–405.
IEEE
[1]
K. J. Ploegmakers et al., “Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people : a European survey,” EUROPEAN GERIATRIC MEDICINE, vol. 13, pp. 395–405, 2022.
@article{8734223,
  abstract     = {{Purpose Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support
System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions.
Methods We examined and compared the relative importance and the occurrence of regional differences of a literature based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries.
Results We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were
technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS.
Conclusion When designing a CDSS for Geriatric Medicine, the patient’s medical complexity must be addressed whilst
maintaining the doctor’s decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients.}},
  author       = {{Ploegmakers, Kim J. and Medlock, Stephanie and Linn, Annemiek J. and Lin, Yumin and Seppälä, Lotta J. and Petrovic, Mirko and Topinkova, Eva and Ryg, Jesper and Mora, Maria Angeles Caballero and Landi, Francesco and Thaler, Heinrich and Szczerbińska, Katarzyna and Hartikainen, Sirpa and Bahat, Gulistan and Ilhan, Birkan and Morrissey, Yvonne and Masud, Tahir and van der Velde, Nathalie and van Weert, Julia C. M.}},
  issn         = {{1878-7649}},
  journal      = {{EUROPEAN GERIATRIC MEDICINE}},
  keywords     = {{Clinical Decision Support System (CDSS),barriers,facilitators,medication review,falls prevention,EVIDENCE-BASED MEDICINE,INCREASING DRUGS,PRESCRIPTION,ACCEPTANCE,TRIALS,ALERTS}},
  language     = {{eng}},
  pages        = {{395--405}},
  title        = {{Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people : a European survey}},
  url          = {{http://doi.org/10.1007/s41999-021-00599-w}},
  volume       = {{13}},
  year         = {{2022}},
}
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