药物充足性临床决策支持系统的有效方法:最佳技术采用的整体评估

IF 3.4 3区 医学 Q1 HEALTH POLICY & SERVICES
Carla Fernández-Barceló , Elena Calvo-Cidoncha , Laura Sampietro-Colom
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引用次数: 0

摘要

引言最近,卫生技术评估(HTA)已将其范围缩小到主要分析临床和经济效益。最近的挑战强调需要进行全面评估,以获得准确的决策建议,同时考虑到经验事实和利益攸关方的价值观。VALIDATE方法考虑了利益相关者的观点和经验事实,从而实现更全面的HTA。本研究使用VALIDATE对临床决策支持系统(CDSS)进行了评估。方法对文献进行了系统回顾,以收集有关CDSS有效性和已发表的利益相关者观点的证据。考虑到检索到的信息,对利益相关者进行了半结构化访谈,以揭示围绕CDSS的问题,如关于药物错误发生的问题定义、对现有预防方法的判断和以前使用CDSS的经验、关于对未来影响的思考和个人信念的背景理论,以及执行方面的障碍/促进者。结果当包括多方利益相关者的观点时,与文献不同的原因被证明会干扰CDSS的接受/实施,例如:i)脑脊髓炎的发生(所服用药物的可追溯性/患者能力差),ii)作为预防脑脊髓炎工具的技术(如果仅在一个护理点实施,则不足),iii)CDSS的以往经验(由于医院最终将处方数字化,CDSS发展较低)和iv)CDSS指标(应测量输入的数据以控制CDSS的性能)。结论在范围界定技术评估中纳入多利益相关者的观点为评估带来了附加值和新信息,从而实现更全面的评估;否则,它可能会导致信息不准确,从而导致是否、何时以及如何采用CDSS的决策不准确。公共利益总结将不同的利益相关者纳入卫生技术评估,可以更深入地了解技术能带来什么价值。本研究开发了一个考虑不同利益相关者的临床决策支持系统(CDSS)评估框架。他们接受了采访,以了解他们对CDSS试图解决的问题(药物错误)和解决方案本身(CDSS)的不同部分的看法。访谈中的一些原因与迄今为止发表的文献不同,这些原因被证明阻碍了CDSS的接受/实施,例如:所服用的药物没有可追溯性/患者能力较差,CDSS如果只在一个护理点实施是不够的,由于药物处方在医院最后数字化和CDSS指标(应测量输入的数据以控制CDSS的性能),CDSS的发展较低。这种方法可以提高CDSS的实施机会和后验评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
VALIDATE approach on medication adequacy clinical decision support systems: Holistic assessment for optimal technology adoption

Introduction

Lately, Health Technology Assessment (HTA) has narrowed its scope to analyses of mainly clinical and economic benefits. Recent challenges emphasize the need for holistic assessments to obtain accurate recommendations for decision-making considering empirical facts and stakeholder's values. VALIDATE approach considers stakeholder's views and empirical facts allowing for more comprehensive HTAs. This study frames the assessment for clinical decision support systems (CDSS) using VALIDATE.

Methods

A systematic review of the literature was conducted to gather evidence on the CDSS's effectiveness and published stakeholder perspectives. Considering the retrieved information, semi-structured interviews with stakeholders were conducted to uncover issues around CDSSs such as problem definition regarding the occurrence of medication errors, judgement of existing preventive methods and previous experiences with CDSSs, background theories regarding thoughts on future impact and personal beliefs, and barriers/facilitators for implementation.

Results

When including multi-stakeholder views, reasons different from the literature are shown to interfere with CDSS acceptance/implementation, such as: i) Occurrence of ME (no traceability of medication taken/poor patient empowerment), ii) Technology as a tool to prevent ME (insufficient if only implemented at one point-of-care), iii) Previous experiences with CDSSs (low CDSSs development due to drug prescription being lastly digitalized in hospitals) and iv) CDSSs metrics (data inputted should be measured to control CDSSs performance).

Conclusion

Including multi-stakeholders views in scoping technology evaluation brings added value and new information for the assessment, resulting in more comprehensive assessment; otherwise, it can lead to inaccurate information resulting in inaccurate decisions on if, when and how to adopt CDSS.

Public Interest Summary

Including varied stakeholders into health technology assessment provides a deeper understanding of what value can a technology bring in. The present study develops a framework to assess clinical decision support systems (CDSS) considering different stakeholders. They were interviewed to understand their perspective on different parts of the problem CDSSs try to solve (medication errors) and the solution itself (CDSSs). Some reasons on the interviews were different from the literature published so far, that are shown to hinder CDSS acceptance/implementation, such as: no traceability of medication taken/poor patient empowerment, CDSSs being insufficient if only implemented at one point-of-care, low CDSSs development due to drug prescription being lastly digitalized in hospitals and CDSS metrics (data inputted should be measured to control CDSSs performance). This approach can improve both implementation chances and posterior assessment of CDSSs.

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来源期刊
Health Policy and Technology
Health Policy and Technology Medicine-Health Policy
CiteScore
9.20
自引率
3.30%
发文量
78
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
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