A Clinical Decision Support System for the promotion of the prudent use of antibiotics in hospitals - Early stages of the development process

Background Currently, physicians have to deal with an excessive workload and difficult working-conditions. The quantity of work can result in inappropriate decisions to clinical problems. Also within the field of infectious diseases, suboptimal decisions are made with regard to the prescription of antibiotics. The increasing resistance of bacteria to the treatment with antimicrobial substances can be ascribed to a heavy rise in the usage of antibiotics. This can result in a major safety problem for patients because current treatments may not be effective anymore. A Clinical Decision Support (CDS) system can be one solution to this problem. CDS-systems seem to be effective in improving health care processes and facilitating evidenced based medicine. They also seem to work as an improvement strategy for the enhancement of the prescribing behaviour for antibiotics among physicians. The aim of this paper was to inventory essential preconditions to a CDS-system with regard to the prescription of antibiotics. These preconditions include functional and persuasive features, which could be integrated in a CDS-system. Methods Firstly a quick scan of the literature has been conducted to identify essential features, which are associated with a successful CDS-system. Secondly, one round of a Delphi study has been completed to get insight into which diagnostics tests physicians find important in clinical practise. 49 physicians of six different Dutch hospitals completed the questionnaire. Thirdly, six interviews among physicians have been held to get insight into their expectations with regard to such a system. A mock-up of a CDS-system has been used as a guide of reference throughout the interviews. Results Overall, the quick scan of the literature shows mainly positive results in favour for a CDS-system. Three types of system could be distinguished: systems that help physicians in confirming or ruling out an infection, give treatment recommendations or support in changing the initial antibiotic therapy. The Delphi study shows a low overall consensus of the rating of the diagnostic tests. The reached consensus differs per case presented in the questionnaire, reaching from only 16 to up to 48 per cent However, vital sign tests get the highest overall rating and could therefore be integrated in a CDS-system to confirm of rule out an infection. The interviewees find the following functional features useful: the feature “allergies”, giving different recommendations if a patient is allergic to a certain antimicrobial drug and the link to an information database. Regarding the content they would find useful if a system provided information on the duration of therapy, contra-indications and adverse events. Transparency of the system seems to be very important. Conclusion There are big differences between hospitals and between wards within hospitals, regarding guidelines, scores and procedures. A CDS-system should therefore be hospital and/or even ward-specific. Physicians want to get supported in confirming or ruling out an infection and finding an appropriate treatment, less in changing the initial antibiotic therapy.