Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool
Abstract Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can he...
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| Format: | Article |
| Language: | English |
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BMC
2021-04-01
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| Series: | BMC Medical Informatics and Decision Making |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12911-021-01484-z |
| _version_ | 1818730064649388032 |
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| author | Melissa T. Baysari Mai H. Duong Patrick Hooper Michaela Stockey-Bridge Selvana Awad Wu Yi Zheng Sarah N. Hilmer |
| author_facet | Melissa T. Baysari Mai H. Duong Patrick Hooper Michaela Stockey-Bridge Selvana Awad Wu Yi Zheng Sarah N. Hilmer |
| author_sort | Melissa T. Baysari |
| collection | DOAJ |
| description | Abstract Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice. Methods Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient’s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists. Results Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback. Conclusion Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care. |
| first_indexed | 2024-12-17T22:55:51Z |
| format | Article |
| id | doaj.art-4aa71bd3402e4d28bd99ff3e02a34ef3 |
| institution | Directory Open Access Journal |
| issn | 1472-6947 |
| language | English |
| last_indexed | 2024-12-17T22:55:51Z |
| publishDate | 2021-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medical Informatics and Decision Making |
| spelling | doaj.art-4aa71bd3402e4d28bd99ff3e02a34ef32022-12-21T21:29:33ZengBMCBMC Medical Informatics and Decision Making1472-69472021-04-012111810.1186/s12911-021-01484-zSupporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support toolMelissa T. Baysari0Mai H. Duong1Patrick Hooper2Michaela Stockey-Bridge3Selvana Awad4Wu Yi Zheng5Sarah N. Hilmer6Discipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, D17, The University of SydneyKolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore HospitaleMR Connect Program, eHealth NSWClinical Engagement and Patient Safety, eHealth NSWClinical Engagement and Patient Safety, eHealth NSWDiscipline of Biomedical Informatics and Digital Health, Faculty of Medicine and Health, Charles Perkins Centre, D17, The University of SydneyKolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney and Royal North Shore HospitalAbstract Background Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice. Methods Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient’s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists. Results Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback. Conclusion Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care.https://doi.org/10.1186/s12911-021-01484-zComputerised decision supportDeprescribingUsabilityPolypharmacyHospital |
| spellingShingle | Melissa T. Baysari Mai H. Duong Patrick Hooper Michaela Stockey-Bridge Selvana Awad Wu Yi Zheng Sarah N. Hilmer Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool BMC Medical Informatics and Decision Making Computerised decision support Deprescribing Usability Polypharmacy Hospital |
| title | Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool |
| title_full | Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool |
| title_fullStr | Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool |
| title_full_unstemmed | Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool |
| title_short | Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool |
| title_sort | supporting deprescribing in hospitalised patients formative usability testing of a computerised decision support tool |
| topic | Computerised decision support Deprescribing Usability Polypharmacy Hospital |
| url | https://doi.org/10.1186/s12911-021-01484-z |
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