Computerised decision support to aid primary care clinicians in the management of specialist drugs : an evaluation of the needs of UK General Practitioners (GPs)

• Main Author: Chana, Narinder Singh
• Other Authors: Delaney, Brendan Clifford ; Whittlesea, Catherine Margaret Cecilia
• Published: King's College London (University of London) 2015
• Subjects: 362.1
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.677070

In the UK since the early 1990s there has been a growing trend for certain hospital initiated specialist drugs to be prescribed by GPs within primary care. GPs have been encouraged to undertake this activity supported by the use of so-called “shared care protocols.” Despite these arrangements this has proven difficult with concerns over the quality and availability of shared care protocols and reported safety related incidents including fatalities linked to the use of certain specialist drugs. GPs have benefited from the complete computerisation of general practice unlike their hospital based colleagues who on the whole continue to work and prescribe within paper-based systems. These benefits have included the use of electronic prescribing and the introduction of computerised decision support systems (CDSS) in the form of reminders and drug related warnings and alerts. Scoping reviews are an established way of assessing the evidence base of a subject area which can then be summarised to reflect the broad nature of the field. For this thesis a scoping review of CDSS was used to evaluate how this intervention has been used within primary care and to identify areas where it can be further developed. Although the use of information technology has been suggested as a possible solution to some of the problems at the primary and secondary care interface, no published studies have evaluated the potential for a CDSS to support the prescribing of specialist drugs by GPs. In order to explore this concept further and gain additional knowledge of current CDSS usage, key informants were identified and interviewed. The key informants described the current availability and characteristics of CDSS within UK general practice. The concept of developing a CDSS to support GPs in the use of specialist drugs to include prescribing was acknowledged as beneficial and was widely supported. Enablers and barriers to development and implementation were identified including a number of potential operating models. Key enablers included data quality and functionality features, joint development and implementation and to make use of existing systems and frameworks. Key barriers included addressing the needs of end users, security, regulation and funding. Human ergonomics was used to further investigate GPs and the actual level and use of computers and software programs including CDSS at the point of prescribing both during and outside of patient consultations. The application of an analytical approach to these processes through a task analysis framework identified failings in existing arrangements for GPs to safely prescribe specialist drugs.