A Mixed-method Study to Explore, Assess, and Explain the Translation of a Complex Set of Evidence-based Rules Into Practice Through Electronic Medical Record Based Decision Support: How Can STOPP Effectively be Deployed in Primary Care?
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 28
- 试验地点
- 1
- 主要终点
- Change in rate of potentially inappropriate prescribing
研究概览
简要总结
This mixed methods study seeks to assess and understand the impact of using an advanced CDS tool to present the STOPP criteria to support prescribers at the point of decision-making. We ask the overarching question:
**How can clinical decision support tools effectively translate a complex set of evidence-based rules into primary care clinical practice?**
The work is divided into 2 phases.
PHASE 1: Randomized control trial. We will measure change in potentially inappropriate prescribing by primary care prescribers (e.g. family doctors) who are using the Clinical Decision Support (CDS) tool in their Electronic Medical Record (EMR), as compared to those who are not. Potentially Inappropriate Prescribing is defined by the STOPP criteria, the same criteria that will be used in the clinical decision support tool in the EMR. We will use the OSCAR EMR for this study. EMR based queries will be developed to assess the number of potentially inappropriate prescriptions are current in each of 12 physician practices at baseline and at 16 weeks.
PHASE 2: We will then complete a qualitative follow up with participants to aid in understanding how primary care prescribers perceived the CDS. This will help explain Phase 1 findings and provide additional information to enhance future decision support tools.
详细描述
The STOPP (Screening Tool of Older People's potentially inappropriate Prescriptions) criteria are a previously clinically validated set of suggested medications to avoid in patients aged 65+ with certain characteristics (e.g. benzodiazepines should be avoided in those with a fall history). These have previously been translated into point of care reminders that can be used with the OSCAR Electronic Medical Record (EMR) so that physicians are notified of potentially inappropriate prescriptions when a patient's chart is opened. This two phase explanatory study will examine if those STOPP based point of care prescribing alerts as presented to physicians in the OSCAR EMR can change potentially inappropriate prescribing patterns in primary care physicians.
PHASE 1:
A cluster randomized control trial in private primary care physician offices. The intervention is at the level of the physician and consists of activating the set of STOPP based alerts for the physician so that they see them during their workflow. These alerts will be triggered and displayed to physicians at the point of care. The alerts will suggest the physician consider Potentially Inappropriate Prescriptions (PIPs), as defined by STOPP. The control group will not have the alerts presented. (STOPP criteria are described in the full proposal, attached).
The primary outcome measure is a composite indicator:
- Δ in Number of PIPs in patients >64yo with a visit during the intervention
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
入排标准
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Have been using the OSCAR EMR v 12.x for >12 months (to provide enough time for medications to be consistently documented in the EMR).
- •Have OSCAR EMR installed locally in the practice.
- •Agree to be or are already a part of the University of British Columbia's Department of Family Practice's (UBC DFP) research network.
- •Ensure their OSCAR Service Provider (OSP) agrees to support the research network hardware/software installation.
- •Have not used the STOPP criteria in OSCAR prior to the study.
排除标准
- •Non-prescribers.
- •Those who do not provide longitudinal care (e.g. walk-in clinics).
- •Specialists or midwives.
- •Those who do not have regular patients over age 64 (e.g. maternity clinics).
- •Those who do not use OSCAR 12.1 or those that do not document prescriptions in their EMR prescription module.
- •Those who have ALREADY used the STOPP rules in OSCAR prior to the study.
结局指标
主要结局
Change in rate of potentially inappropriate prescribing
时间窗: Baseline, 8 weeks, 16 weeks
Reports will be run on EMR data to provide summary statistics to count rates for potentially inappropriate prescriptions. The reports will be generated using a series of queries that are consistent with the rules that trigger the CDS alerts. Change will be determined between baseline and 8 weeks and baseline and 16 weeks.
次要结局
- Change in rates of Potentially Inappropriate Prescribing for Individual STOPP Criteria(16 weeks)
- Qualitative User Assessment of Decision Support(Point in Time after intervention)
研究者
Morgan Price
Assistant Professor
University of British Columbia