Computerized clinical decision support systems for prescribing in primary care: Characteristics and implementation impact. Scoping review and evidence and gap maps

IF 3.4 3区医学 Q1 HEALTH POLICY & SERVICES

Health Policy and Technology Pub Date : 2025-01-30 DOI:10.1016/j.hlpt.2025.100976

Héctor Acosta-García , Juan Ruano-Ruiz , Francisco José Gómez-García , Susana Sánchez-Fidalgo , Bernardo Santos-Ramos , Teresa Molina-López

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引用次数: 0

Abstract

This study aimed to conduct a scoping review and evidence and gap maps to characterize Clinical Decision Support Systems (CDSS) in primary care, evaluate their implementation and maintenance levels, and identify evidence gaps. Methods: A literature search covering January 2010 to May 2023 was conducted across various databases. Inclusion criteria encompassed studies involving real patients with detailed descriptions of CDSS, including both comparative and descriptive designs within primary care settings. Two independent reviewers screened the references, while four researchers independently extracted data, which included demographics, main findings, and system descriptions. The results were presented using interactive evidence and gap maps. Results: Among 1,447 initial citations, 75 studies met the selection criteria. The identified types of CDSS included adherence to guidelines/local protocols (45 %), antibiotic prescription (16 %), suitability (15 %), and others. Only one system was classified as "intelligent," while 39 % received a complexity rating of 4 on a scale from 1 to 5. Assessment of various outcomes across the studies revealed health outcomes (20 %), economy/resource use (13 %), potentially inappropriate prescription (61 %), adherence to local guidelines/protocols (12 %), and acceptance/use (40 %). Two maps were created: The first one displayed the type of CDSS linked to the type of results measured. The second one showed the type of CDSS and their most relevant characteristics. Data were represented in a dynamic bubble diagram. Conclusion: Current evidence regarding CDSS in primary care is limited and heterogeneous. The identified systems exhibit relative complexity but are not classified as intelligent, primarily focusing on improving prescribing practices through clinical guidelines or prescription aid tools. The outcomes most frequently assessed included potentially inappropriate prescriptions and acceptance/use. The evidence and gap maps provide a user-friendly format for visualizing existing evidence and identifying research gaps in the implementation of CDSS within primary care.

Systematic Review registration: This study is registered in Open Science Framework. https://bit.ly/2RqKrWp

Results data: EGMs: The complete EGMs can be accessed at the following link: https://proyectos.imibic.org/evidence-map/

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来源期刊

Health Policy and Technology Medicine-Health Policy

CiteScore

9.20

自引率

3.30%

发文量

审稿时长

88 days

期刊介绍： Health Policy and Technology (HPT), is the official journal of the Fellowship of Postgraduate Medicine (FPM), a cross-disciplinary journal, which focuses on past, present and future health policy and the role of technology in clinical and non-clinical national and international health environments. HPT provides a further excellent way for the FPM to continue to make important national and international contributions to development of policy and practice within medicine and related disciplines. The aim of HPT is to publish relevant, timely and accessible articles and commentaries to support policy-makers, health professionals, health technology providers, patient groups and academia interested in health policy and technology. Topics covered by HPT will include: - Health technology, including drug discovery, diagnostics, medicines, devices, therapeutic delivery and eHealth systems - Cross-national comparisons on health policy using evidence-based approaches - National studies on health policy to determine the outcomes of technology-driven initiatives - Cross-border eHealth including health tourism - The digital divide in mobility, access and affordability of healthcare - Health technology assessment (HTA) methods and tools for evaluating the effectiveness of clinical and non-clinical health technologies - Health and eHealth indicators and benchmarks (measure/metrics) for understanding the adoption and diffusion of health technologies - Health and eHealth models and frameworks to support policy-makers and other stakeholders in decision-making - Stakeholder engagement with health technologies (clinical and patient/citizen buy-in) - Regulation and health economics