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Key summary points: Aim: The aim of our study was to assess barriers and facilitators to CDSS use reported by European physicians treating older fallers and explore differences in their perceptions. Findings: Our main findings were that a barrier to CDSS use is that physicians feel that complex geriatric patients need a physician's clinical judgement and not the advice of a CDSS. Regional differences in barrier and facilitator perceptions occurred across Europe. Message: Our main message is that when designing a CDSS for Geriatric falls patients, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy, and to increase successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Purpose: Fall-Risk Increasing Drugs (FRIDs) are an important and modifiable fall-risk factor. A Clinical Decision Support System (CDSS) could support doctors in optimal FRIDs deprescribing. Understanding barriers and facilitators is important for a successful implementation of any CDSS. We conducted a European survey to assess barriers and facilitators to CDSS use and explored differences in their perceptions. Methods: We examined and compared the relative importance and the occurrence of regional differences of a literature-based list of barriers and facilitators for CDSS usage among physicians treating older fallers from 11 European countries. Results: We surveyed 581 physicians (mean age 44.9 years, 64.5% female, 71.3% geriatricians). The main barriers were technical issues (66%) and indicating a reason before overriding an alert (58%). The main facilitators were a CDSS that is beneficial for patient care (68%) and easy-to-use (64%). We identified regional differences, e.g., expense and legal issues were barriers for significantly more Eastern-European physicians compared to other regions, while training was selected less often as a facilitator by West-European physicians. Some physicians believed that due to the medical complexity of their patients, their own clinical judgement is better than advice from the CDSS. Conclusion: When designing a CDSS for Geriatric Medicine, the patient's medical complexity must be addressed whilst maintaining the doctor's decision-making autonomy. For a successful CDSS implementation in Europe, regional differences in barrier perception should be overcome. Equipping a CDSS with prediction models has the potential to provide individualized recommendations for deprescribing FRIDs in older falls patients. [ABSTRACT FROM AUTHOR]