Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record
Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record
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DOI：
10.2196/17785
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发表时间：
2020-09-01
影响因子：
2.2
通讯作者：
Manski-Nankervis, Jo-Anne
中科院分区：
文献类型：
--
作者：
Kunstler, Breanne E.;Furler, John;Manski-Nankervis, Jo-Anne
背景：管理2型糖尿病（T2D）需要逐步改变生活方式，有时需要强化药物治疗。全科医生（GP）是这一过程的组成部分，但由于不断出现的治疗方案的复杂性，他们可能会发现药物治疗强化具有挑战性。目的：本研究旨在使用协同设计方法开发和预测试临床决策支持（CDS）工具原型（GlycASSIST）嵌入在电子医疗记录中，它使用循证指南为全科医生和T2D患者提供设置糖化血红蛋白（HbA1c）的建议目标和强化治疗一起在真实的时间在consultation.Methods：T2D相关的CDS工具的文献通知初始GlycASSIST设计。然后使用两部分协同设计方法。通过与临床医生（4名全科医生，5名内分泌学家和3名糖尿病教育工作者）和6名T2D患者的访谈和焦点小组寻求初步反馈。经过改进后，8名全科医生参加了模拟磋商，他们可以使用GlycASSIST。6名T2D患者观看了类似的模拟咨询。与会者提供反馈的功能GlycASSIST和它的作用，支持共享决策（SDM）和治疗intensified.Results：临床医生和T2D的人认为，GlycASSIST可以支持SDM（虽然这并不总是观察到在模拟咨询）和个性化的治疗强化。他们建议GlycASSIST包含更少的信息，同时保持相关性和可信度，并使用图形和颜色来增强视觉吸引力。保持临床自主性对全科医生来说很重要，因为他们希望能够在适当的时候推翻GlycASSIST的建议。临床医生要求更容易的屏幕导航和更大的处方指导和capability.Conclusions：GlycASSIST被认为是实现其目的，促进治疗强化，是可以接受的人与T2D和GP。GlycASSIST原型正在根据这些发现进行改进，为定量评估做准备。
Background: Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options.Objective: This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations.Methods: The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification.Results: Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST's recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities.Conclusions: GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation.