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A systematic review of clinical decision support systems for antimicrobial management: Are we failing to investigate these interventions appropriately?

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Title: A systematic review of clinical decision support systems for antimicrobial management: Are we failing to investigate these interventions appropriately?
Authors: Rawson, T
Moore, L
Hernandez, B
Charani, E
Castro Sanchez, E
Herrero, P
Hayhoe, B
Hope, W
Georgiou, P
Holmes, A
Item Type: Journal Article
Abstract: Objectives Clinical decision support systems (CDSS) for antimicrobial management can support clinicians to optimise antimicrobial therapy. We reviewed all original literature (qualitative and quantitative) to understand the current scope of CDSS for antimicrobial management and analyse existing methods used to evaluate and report such systems. Method PRISMA guidelines were followed. Medline, EMBASE, HMIC Health and Management, and Global Health databases were searched from 1st January 1980 to 31st October 2015. All primary research studies describing CDSS for antimicrobial management in adults in primary or secondary care were included. For qualitative studies, thematic synthesis was performed. Quality was assessed using Integrated quality Criteria for the Review Of Multiple Study designs (ICROMS) criteria. CDSS reporting was assessed against a reporting framework for behaviour change intervention implementation. Results Fifty-eight original articles were included describing 38 independent CDSS. The majority of systems target antimicrobial prescribing (29/38;76%), are platforms integrated with electronic medical records (28/38;74%), and have rules based infrastructure providing decision support (29/38;76%). On evaluation against the intervention reporting framework, CDSS studies fail to report consideration of the non-expert, end-user workflow. They have narrow focus, such as antimicrobial selection, and use proxy outcome measures. Engagement with CDSS by clinicians was poor. Conclusion Greater consideration of the factors that drive non-expert decision making must be considered when designing CDSS interventions. Future work must aim to expand CDSS beyond simply selecting appropriate antimicrobials with clear and systematic reporting frameworks for CDSS interventions developed to address current gaps identified in the reporting of evidence.
Issue Date: 6-Mar-2017
Date of Acceptance: 27-Feb-2017
URI: http://hdl.handle.net/10044/1/45082
DOI: https://dx.doi.org/10.1016/j.cmi.2017.02.028
ISSN: 1469-0691
Publisher: Elsevier
Start Page: 524
End Page: 532
Journal / Book Title: Clinical Microbiology and Infection
Volume: 23
Issue: 8
Copyright Statement: © 2017 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/)
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
National Institute for Health Research
Funder's Grant Number: HPRU-2012-10047
HPRU-2012-10047
II-LA-0214-20008
II-LA-0214-20008
Keywords: Science & Technology
Life Sciences & Biomedicine
Infectious Diseases
Microbiology
Antimicrobial resistance
Antimicrobial stewardship
Decision algorithms
Electronic support
ACUTE RESPIRATORY-INFECTIONS
CLUSTER RANDOMIZED-TRIAL
INTENSIVE-CARE-UNIT
ELECTRONIC HEALTH RECORDS
URINARY-TRACT-INFECTIONS
ANTIBIOTIC USE
HOSPITALIZED-PATIENTS
APPROVAL SYSTEM
TIME-SERIES
IMPROVE
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Faculty of Engineering
Electrical and Electronic Engineering
Department of Medicine
Faculty of Medicine
Epidemiology, Public Health and Primary Care



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