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The role of clinical decision tools in chronic disease care
Through RACGP Foundation-supported research, a GP academic is hoping to put an end to ‘blanket recommendations’ for chronic disease.
Dr Winnie Chen has recently published two systematic reviews, supported by her work with the RACGP Foundation.
Dr Winnie Chen is keen to inform the general practice community on what digital health tools work best.
The GP researcher was awarded the 2020 RACGP Foundation Chris Silagy Research Scholarship to conduct a systematic review on clinical decision support interventions in chronic disease care, and following the recent publication of her research, she is planning to present her findings at GP22.
The studies involved a review of more than 100 individual articles with electronic health record-based clinical decision support tools in cardiovascular disease (CVD), diabetes, chronic kidney disease, hypertension and hypercholesterolaemia.
The first published review looked at the design, effectiveness, and economic outcomes of these interventions. But according to Dr Chen, even where tools are effective, ‘there is no guarantee’ that clinicians will use them.
‘[That’s why] in our second publication, we looked at qualitative studies to summarise barriers and enablers to using these digital tools,’ she told newsGP.
The systematic review and meta-analysis for Dr Chen’s research found that effectiveness and cost-effectiveness varied greatly between decision support interventions, and what that means in the general practice context.
‘This is likely because of differences in the tools themselves, as well as differences in where and how the tools were implemented,’ she said.
‘One important finding for general practice was that the design of chronic disease tools tends to be disease specific. For example, there may be one tool for kidney disease, another for CVD, and yet another for atrial fibrillation.
‘The reality is that GPs and other clinicians are increasingly dealing with complex multimorbidity.’
There are many examples, according to Dr Chen, such as a ‘simplistic algorithm’ that prompts GPs to prescribe a guideline-recommended medication for hypertension may not take account of co-existing cardiovascular conditions.
Or a ‘specialty-specific tool’ that only works to prompt screening for abdominal aortic aneurysm has limited applicability in clinical practice.
‘Clinicians are frustrated with tools that provide blanket recommendations, and tools that result in excessive alerts,’ she said.
To help address these challenges, Dr Chen is hoping the two systematic reviews will help to inform existing and future projects to design more efficient and user-friendly clinical decision support tools.
The qualitative component of the review also
provides recommendations on clinical, user, external context, and technical factors to consider when implementing these tools.
‘Many of these recommendations are relevant not only to research teams in our field, but more broadly to those working to implement other digital health projects,’ Dr Chen said.
The systematic review is also the first of several studies for Dr Chen’s
PhD at Menzies School of Health Research, where she is working to develop, implement, and evaluate a chronic disease clinical decision support tool.
‘The review helps our team to learn from the positive and negative experiences from previous studies,’ she said.
Dr Chen anticipates GP22 will be a valuable opportunity for further engagement with the general practice community.
‘I look forward to hearing in-person from other GPs across Australia about what tools they use, and learn from others working in this space,’ she said.
More information about the RACGP Foundation and applications for the 2023 grants are available on the Foundation website.
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