Understanding “Alert Fatigue” in Primary Care: Qualitative Systematic Review of General Practitioners Attitudes and Experiences of Clinical Alerts, Prompts, and Reminders
Authors: Gani Illin , Litchfield Ian , Shukla David , Delanerolle Gayathri , Cockburn Neil , Pathmanathan Anna 
Published: February 2025

Background
The consistency and quality of care in modern primary care are supported by various clinical reminders (CRs), which include “alerts” describing the consequences of certain decisions and “prompts” that remind users to perform tasks promoting desirable clinical behaviors. However, not all CRs are acted upon, and many are disregarded by general practitioners (GPs), a chronic issue commonly referred to as “alert fatigue.” This phenomenon has significant implications for the safety and quality of care, GP burnout, and broader medicolegal consequences. Research on mitigating alert fatigue and optimizing the use of CRs remains limited. This review offers much-needed insight into GP attitudes toward the deployment, design, and overall effectiveness of CRs.

Objective
This systematic review aims to synthesize current qualitative research on GPs’ attitudes toward CRs, enabling an exploration of the interacting influences on the occurrence of alert fatigue in GPs, including the deployment, design, and perceived efficacy of CRs.

Methods
A systematic literature search was conducted across the Health Technology Assessment database, MEDLINE, MEDLINE In-Process, Embase, CINAHL, Conference Proceedings Citation Index, PsycINFO, and OpenGrey. The search focused on primary qualitative and mixed methods research conducted in general or family practice, specifically exploring GPs’ experiences with CRs. All databases were searched from inception to December 31, 2023. To ensure structured and practicable findings, we used a directed content analysis of the data, guided by the 7 domains of the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework, including domains related to Technology, Adopter attitudes, and Organization.

Results
A total of 9 studies were included, and the findings were organized within the 7 domains. Regarding Condition and Value Proposition, GPs viewed CRs as an effective way to maintain or improve the safety and quality of care they provide. When considering the attributes of the Technology, the efficacy of CRs was linked to their frequency, presentation, and the accuracy of their content. Within Adopters, concerns were raised about the accuracy of CRs and the risk that their use could diminish the value of GP experience and contextual understanding. From an Organization perspective, the need for training on the use and benefits of CRs was highlighted. Finally, in the context of the Wider system and their Embedding Over Time, suggestions included sharing best practices for CR use and involving GPs in their design.

Conclusions
While GPs acknowledged that CRs, when used optimally, can enhance patient safety and quality of care, several concerns emerged regarding their design, content accuracy, and lack of contextual nuance. Suggestions to improve CR adherence included providing coherent training, enhancing their design, and incorporating more personalized content.

Trial Registration
PROSPERO CRD42016029418; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=29418

International Registered Report Identifier (IRRID)
RR2-10.1186/s13643-017-0627-z