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Development of the ADFICE_IT clinical decision support system to assist deprescribing of fall-risk increasing drugs: A user-centered design approach.

Authors :
Groos SS
de Wildt KK
van de Loo B
Linn AJ
Medlock S
Shaw KM
Herman EK
Seppala LJ
Ploegmakers KJ
van Schoor NM
van Weert JCM
van der Velde N
Source :
PloS one [PLoS One] 2024 Sep 05; Vol. 19 (9), pp. e0297703. Date of Electronic Publication: 2024 Sep 05 (Print Publication: 2024).
Publication Year :
2024

Abstract

Introduction: Deprescribing fall-risk increasing drugs (FRIDs) is promising for reducing the risk of falling in older adults. Applying appropriate deprescribing in practice can be difficult due to the outcome uncertainties associated with stopping FRIDs. The ADFICE_IT intervention addresses this complexity with a clinical decision support system (CDSS) that facilitates optimum deprescribing of FRIDs by using a fall-risk prediction model, aggregation of deprescribing guidelines, and joint medication management.<br />Methods: The development process of the CDSS is described in this paper. Development followed a user-centered design approach in which users and experts were involved throughout each phase. In phase I, a prototype of the CDSS was developed which involved a literature and systematic review, European survey (n = 581), and semi-structured interviews with clinicians (n = 19), as well as the aggregation and testing of deprescribing guidelines and the development of the fall-risk prediction model. In phase II, the feasibility of the CDSS was tested by means of two usability testing rounds with users (n = 11).<br />Results: The final CDSS consists of five web pages. A connection between the Electronic Health Record allows for the retrieval of patient data into the CDSS. Key design requirements for the CDSS include easy-to-use features for fast-paced clinical environments, actionable deprescribing recommendations, information transparency, and visualization of the patient's fall-risk estimation. Key elements for the software include a modular architecture, open source, and good security.<br />Conclusion: The ADFICE_IT CDSS supports physicians in deprescribing FRIDs optimally to prevent falls in older patients. Due to continuous user and expert involvement, each new feedback round led to an improved version of the system. Currently, a cluster-randomized controlled trial with process evaluation at hospitals in the Netherlands is being conducted to test the effect of the CDSS on falls. The trial is registered with ClinicalTrials.gov (date; 7-7-2022, identifier: NCT05449470).<br />Competing Interests: The authors have declared that no competing interests exist.<br /> (Copyright: © 2024 Groos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Details

Language :
English
ISSN :
1932-6203
Volume :
19
Issue :
9
Database :
MEDLINE
Journal :
PloS one
Publication Type :
Academic Journal
Accession number :
39236057
Full Text :
https://doi.org/10.1371/journal.pone.0297703