Barriers to Adoption of Tailored Drug-Drug Interaction Clinical Decision Support.
Barriers to Adoption of Tailored Drug-Drug Interaction Clinical Decision Support.
复制标题
采用定制药物相互作用临床决策支持的障碍。
DOI：
10.1055/s-0043-1772686
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发表时间：
2023
影响因子：
2.9
通讯作者：
Malone,DanielC
中科院分区：
文献类型：
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作者：
Zhang,Tianyi;Gephart,SheilaM;Subbian,Vignesh;Boyce,RichardD;Villa-Zapata,Lorenzo;Tan,MalindaS;Horn,John;Gomez-Lumbreras,Ainhoa;Romero,AndrewV;Malone,DanielC
尽管量身定制的药物相互作用（DDI）警报和广泛的传播策略的好处，我们的定制DDI警报算法，增强与患者特定和特定环境的因素的吸收一直是有限的。该研究的目标是检查障碍和医疗保健系统的动态实施量身定制的DDI警报，并确定的因素，将推动优化和改进的DDI alerts.MethodsWe采用了定性研究的方法，进行采访的参与者采访指南框架的基础上普罗克特的分类实施成果和通知的理论领域框架。参与者包括在医院内担任信息学角色的药剂师，首席医疗信息官和副医疗信息主任/官员。我们的数据分析是由扎根理论分析中使用的技术告知的，开放编码结果的报告是基于安全相关电子健康记录研究报告框架的修改版本。结果我们的分析产生了15个障碍，我们绘制了这些障碍的相互联系，这些障碍围绕三个实体（即，用户、组织和技术利益相关者）。我们的研究结果表明，不一致的利益DDI警报性能和不一致的期望DDI警报优化这些实体之间的医疗机构可能会导致系统惯性在实施定制DDI alerts.ConclusionHealth医疗机构主要确定DDI警报的实施和优化，而且，确定和展示医疗保健组织优先考虑的价值指标以实现定制的DDI警报实施至关重要。这可以通过多方面的方法来实现，例如与有能力采用定制DDI警报的医疗保健组织合作，并确定了解用户需求的专家，与组织和供应商联络，并促进技术利益攸关方的工作。在未来，研究人员可以采用系统化的方法从其他系统的角度（例如，供应商系统）。
ObjectiveDespite the benefits of the tailored drug–drug interaction (DDI) alerts and the broad dissemination strategy, the uptake of our tailored DDI alert algorithms that are enhanced with patient-specific and context-specific factors has been limited. The goal of the study was to examine barriers and health care system dynamics related to implementing tailored DDI alerts and identify the factors that would drive optimization and improvement of DDI alerts.MethodsWe employed a qualitative research approach, conducting interviews with a participant interview guide framed based on Proctor's taxonomy of implementation outcomes and informed by the Theoretical Domains Framework. Participants included pharmacists with informatics roles within hospitals, chief medical informatics officers, and associate medical informatics directors/officers. Our data analysis was informed by the technique used in grounded theory analysis, and the reporting of open coding results was based on a modified version of the Safety-Related Electronic Health Record Research Reporting Framework.ResultsOur analysis generated 15 barriers, and we mapped the interconnections of these barriers, which clustered around three entities (i.e., users, organizations, and technical stakeholders). Our findings revealed that misaligned interests regarding DDI alert performance and misaligned expectations regarding DDI alert optimizations among these entities within health care organizations could result in system inertia in implementing tailored DDI alerts.ConclusionHealth care organizations primarily determine the implementation and optimization of DDI alerts, and it is essential to identify and demonstrate value metrics that health care organizations prioritize to enable tailored DDI alert implementation. This could be achieved via a multifaceted approach, such as partnering with health care organizations that have the capacity to adopt tailored DDI alerts and identifying specialists who know users' needs, liaise with organizations and vendors, and facilitate technical stakeholders' work. In the future, researchers can adopt the systematic approach to study tailored DDI implementation problems from other system perspectives (e.g., the vendors' system).