BACKGROUND: Clinical decision support systems (CDSS) can modify clinician behaviour, yet the factors influencing their effect remain poorly understood. This study assesses the feasibility and acceptability of a CDSS supporting diagnostic and treatment decisions for @entity1 with suspected @entity5749 . METHODS: Intervention The Optimising Management of Angina (OMA) programme includes a CDSS guiding investigation and medication decisions for clinicians managing @entity1 with new onset @entity5749 , based on English national guidelines, introduced through an educational intervention. Design and @entity1 A mixed methods study i. A study of outcomes among @entity1 presenting with suspected angina in three @entity662 clinics in England before and after introduction of the OMA programme. ii. Observations of clinic processes, interviews and a focus group with health professionals at two @entity662 clinics after delivery of the OMA programme. OUTCOMES: Medication and cardiovascular imaging investigations undertaken within six months of presentation, and concordance of these with the recommendations of the CDSS. Thematic analysis of qualitative data to understand how the CDSS was used. RESULTS: Data were analysed for 285 @entity1 attending @entity662 clinics: 106 before and 179 after delivery of the OMA programme. 40 consultations were observed, 5 clinicians interviewed, and a focus group held after the intervention. The proportion of @entity1 appropriate for diagnostic investigation who received one was 50  % (95 CI 34-66  %) of those before OMA and 59  % (95 CI 48-70  %) of those after OMA. Despite high use of the CDSS (84  % of consultations), observations and interviews revealed difficulty with data entry into the CDSS, and structural and practical barriers to its use. In the majority of cases the CDSS was not used to guide real-time decision making, only being consulted after the @entity1 had left the room. CONCLUSIONS: The OMA CDSS for the management of @entity662 is not feasible in its current form. The CDSS was not used to support decisions about the care of individual @entity1 . A range of barriers to the use of the CDSS were identified, some are easily removed, such as insufficient capture of cardiovascular risk, while others are more deeply embedded in current practice, such as unavailability of some investigations or no prescribing privileges for nurses.

Feasibility and impact of a computerised clinical decision support system on investigation and initial management of new onset XXXX : a mixed methods study.

@entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'patient'] @entity5749 :: ('MESH:D060050', 'Disease') :: ['stable angina'] @entity662 :: ('MESH:D002637', 'Disease') :: ['chest pain']
@entity662 :: (MESH:D002637,Disease) :: ['chest pain']
