General practitioners' attitudes and preparedness towards Clinical Decision Support in e-Prescribing (CDS-eP) adoption in the West of Ireland: a cross sectional study

BackgroundElectronic clinical decision support (CDS) is increasingly establishing its role in evidence-based clinical practice. Considerable evidence supports its enhancement of efficiency in e-Prescribing, but some controversy remains. This study evaluated the practicality and identified the perceived benefits of, and barriers to, its future adoption in the West of Ireland.MethodsThis cross sectional study was carried out by means of a 27-part questionnaire sent to 262 registered general practitioners in Counties Galway, Mayo and Roscommon. The survey domains encompassed general information of individual's practice, current use of CDS and the practitioner's attitudes towards adoption of CDS-eP. Descriptive and inferential analyses were performed to analyse the data collected.ResultsThe overall response rate was 37%. Nearly 92% of respondents employed electronic medical records in their practice. The majority acknowledged the value of electronic CDS in improving prescribing quality (71%) and reducing prescribing errors (84%). Despite a high degree of unfamiliarity (73%), the practitioners were open to the use of CDS-eP (94%) and willing to invest greater resources for its implementation (62%). Lack of a strategic implementation plan (78%) is the main perceived barrier to the incorporation of CDS-eP into clinical practice, followed by i) lack of financial incentives (70%), ii) lack of standardized product software (61%), iii) high sensitivity of drug-drug interaction or medication allergy markers (46%), iv) concern about overriding physicians' prescribing decisions(44%) and v) lack of convincing evidence on the systems' effectiveness (22%).ConclusionsDespite favourable attitudes towards the adoption of CDS-eP, multiple perceived barriers impede its incorporation into clinical practice. These merit further exploration, taking into consideration the structure of the Irish primary health care system, before CDS-eP can be recommended for routine clinical use in the West of Ireland.

[1]  Fang Zhang,et al.  Clinician attitudes towards prescribing and implications for interventions in a multi-specialty group practice. , 2008, Journal of evaluation in clinical practice.

[2]  K. Lapane,et al.  A Mixed Method Study of the Merits of E-Prescribing Drug Alerts in Primary Care , 2008, Journal of General Internal Medicine.

[3]  Robyn Tamblyn,et al.  Reasons for Physician Non-Adherence to Electronic Drug Alerts , 2004, MedInfo.

[4]  Clinical decision support systems use in Wisconsin. , 2007, WMJ : official publication of the State Medical Society of Wisconsin.

[5]  Thomas H. Payne,et al.  Review Paper: Medication-related Clinical Decision Support in Computerized Provider Order Entry Systems: A Review , 2007, J. Am. Medical Informatics Assoc..

[6]  Eta S Berner,et al.  Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[7]  S. Asch,et al.  Clinical Relevance of Automated Drug Alerts From the Perspective of Medical Providers , 2005, American journal of medical quality : the official journal of the American College of Medical Quality.

[8]  James G. Anderson,et al.  Social, ethical and legal barriers to E-health , 2007, Int. J. Medical Informatics.

[9]  E. Balas,et al.  Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success , 2005, BMJ : British Medical Journal.

[10]  J. Hanley,et al.  The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[11]  W. Runciman,et al.  Towards safer drug use in general practice. , 1999, Journal of quality in clinical practice.

[12]  Thomas H. Payne,et al.  Characteristics and override rates of order checks in a practitioner order entry system , 2002, AMIA.

[13]  S. McMullin,et al.  Twelve-Month Drug Cost Savings Related to Use of an Electronic Prescribing System With Integrated Decision Support in Primary Care , 2005, Journal of managed care pharmacy : JMCP.

[14]  Dean F. Sittig,et al.  A survey of factors affecting clinician acceptance of clinical decision support , 2006, BMC Medical Informatics Decis. Mak..

[15]  Jonathan M. Teich,et al.  AMIA Position Paper: Clinical Decision Support in Electronic Prescribing: Recommendations and an Action Plan: Report of the Joint Clinical Decision Support Workgroup , 2005, J. Am. Medical Informatics Assoc..

[16]  Raluca Nagy,et al.  Euro Health Consumer Index 2007 , 2007 .

[17]  M. Clarke,et al.  Increasing response rates to postal questionnaires: systematic review , 2002, BMJ : British Medical Journal.

[18]  J. Kjellberg,et al.  Drug-related problems in general practice: results from a development project in Denmark , 2006, Pharmacy World and Science.

[19]  Roger B. Davis,et al.  Physicians' decisions to override computerized drug alerts in primary care. , 2003, Archives of internal medicine.

[20]  J. Kaczorowski,et al.  Prescribing of potentially inappropriate medications to elderly people. , 2004, Family practice.

[21]  Marc Berg,et al.  Overriding of drug safety alerts in computerized physician order entry. , 2006, Journal of the American Medical Informatics Association : JAMIA.

[22]  Robyn Tamblyn,et al.  A randomized trial of the effectiveness of on-demand versus computer-triggered drug decision support in primary care. , 2008, Journal of the American Medical Informatics Association : JAMIA.

[23]  Martin Frischer,et al.  Barriers to the adoption of computerised decision support systems in general practice consultations: a qualitative study of GPs' perspectives , 2004, Int. J. Medical Informatics.

[24]  Jacob Jacoby,et al.  Is there an optimal number of alternatives for Likert-scale items? Effects of testing time and scale properties. , 1972 .