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Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey

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Key summary points

AbstractSection 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.

AbstractSection 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.

AbstractSection 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.

Abstract

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.

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Acknowledgements

We would like to thank Martine Conreur, Cristina Robijns-Campregher, Anna Hofer, and Pavel Dobes for their help with the translation of the surveys.

Funding

This work was supported by The Clementine Brigitta Maria Dalderup Fund of the Amsterdam University Fund [grant number 8040] and Aging & Later Life innovation grant, Amsterdam Public Health (APH) [2018].

Author information

Authors and Affiliations

  1. Section of Geriatric Medicine, Department of Internal Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, D3-227, Meibergdreef 9, Amsterdam, 1105AZ, The Netherlands

    Kim J. Ploegmakers, Lotta J. Seppälä & Nathalie van der Velde

  2. Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands

    Stephanie Medlock

  3. Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Amsterdam, The Netherlands

    Annemiek J. Linn, Yumin Lin & Julia C. M. van Weert

  4. Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore

    Yumin Lin

  5. Department of Internal Medicine and Paediatrics (Section of Geriatrics), Ghent University, Ghent, Belgium

    Mirko Petrovic

  6. Department of Geriatrics and Gerontology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic

    Eva Topinkova

  7. Faculty of Health and Social Sciences, South Bohemian University, Ceske Budejovice, Czech Republic

    Eva Topinkova

  8. Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark

    Jesper Ryg

  9. Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    Jesper Ryg

  10. Servicio de Geriatría, Hospital General Universitario de Ciudad Real , Ciudad Real, Spain

    Maria Angeles Caballero Mora

  11. Department of Gerontology, Neuroscience and Orthopedics, Catholic University of the Sacred Heart, Rome, Italy

    Francesco Landi

  12. Trauma Center Wien-Meidling, Kundratstrasse 37, 1120, Vienna, Austria

    Heinrich Thaler

  13. Laboratory for Research on Aging Society, Department of Sociology of Medicine, Epidemiology and Preventive Medicine Chair, Faculty of Medicine, Jagiellonian University Medical College, Kraków, Poland

    Katarzyna Szczerbińska

  14. School of Pharmacy, University of Eastern Finland, Kuopio, Finland

    Sirpa Hartikainen

  15. Division of Geriatrics, Department of Internal Medicine, Istanbul Medical School, Istanbul University, Capa, 34093, Istanbul, Turkey

    Gulistan Bahat

  16. Division of Geriatrics, Department of Internal Medicine, Şişli Hamidiye Etfal Training and Research Hospital, University of Medical Sciences, Istanbul, Turkey

    Birkan Ilhan

  17. Health Care of Older People, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK

    Yvonne Morrissey

  18. Nottingham University Hospitals NHS Trust, Nottingham, UK

    Tahir Masud

Authors
  1. Kim J. Ploegmakers
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  2. Stephanie Medlock
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  4. Yumin Lin
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  5. Lotta J. Seppälä
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  7. Eva Topinkova
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  9. Maria Angeles Caballero Mora
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  10. Francesco Landi
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  12. Katarzyna Szczerbińska
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  13. Sirpa Hartikainen
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  14. Gulistan Bahat
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  17. Tahir Masud
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  18. Nathalie van der Velde
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  19. Julia C. M. van Weert
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Consortia

the European Geriatric Medicine Society (EuGMS) Task and Finish group on Fall-Risk Increasing Drugs (FRIDs)

Contributions

KJP, AJL, LJS, MP, ET, JR, MACM, FL, HT, KS, SH, GB, BI, YM, TM, NV, and JCMW contributed to the study conception and design and the material preparation. Data collection was performed by KJP, MP, ET, JR, MACM, FL, HT, KS, SH, GB, BI, YM, TM, and NV. Data analysis was performed by KJP, SM, AJL, YL, and NV. The first draft of the manuscript was written by KJP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Kim J. Ploegmakers.

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Conflict of interest

Sirpa Hartikainen has received lecture fee from Astellas Pharma.

Ethical approval

The Medical Ethical Committee of the Academic Medical Centre of the University of Amsterdam reviewed this study and ruled that no ethical approval was required (W18_285#18.331); this study was approved by the Ethical Committees of the Jagiellonian University in Poland and the Ghent University in Belgium.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Ploegmakers, K.J., Medlock, S., Linn, A.J. et al. Barriers and facilitators in using a Clinical Decision Support System for fall risk management for older people: a European survey. Eur Geriatr Med 13, 395–405 (2022). https://doi.org/10.1007/s41999-021-00599-w

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  • DOI: https://doi.org/10.1007/s41999-021-00599-w

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