Accepted for/Published in: JMIR Medical Informatics
Date Submitted: Nov 26, 2019
Date Accepted: Feb 6, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Development of an electronic clinical decision support system for the management of low back pain in community pharmacy: Mixed methods feasibility study
ABSTRACT
Background:
People with low back pain (LBP) in the community often do not receive evidence-based advice and management. Community pharmacists can play an important role in supporting people with LBP as pharmacists are easily accessible to provide first-line care. However, previous research suggests that pharmacists may not consistently deliver advice that is concordant with guideline recommendations and demonstrate difficulty determining which patients require prompt medical review. A clinical decision support system (CDSS) may enhance first-line care of LBP, but none exist to support the community pharmacist-client consultation.
Objective:
To develop a CDSS to guide first-line care of LBP in the community pharmacy setting, and to evaluate pharmacist reported usability and acceptance of the prototype system.
Methods:
A cross-platform web application for the Apple iPad was developed in conjunction with academic and clinical experts using an iterative user-centered design process during interface design, clinical reasoning, program development, and evaluation. The CDSS was evaluated via one-to-one user-testing with 5 community pharmacists (5 case-vignettes each). Data were collected via video recording, screen capture, survey instrument (system usability scale), and direct observation.
Results:
Pharmacist agreement with CDSS generated self-care, medicines recommendations, and referral advice was 90%, 100%, and 88%, respectively (from total 70 recommendations). Pharmacists expressed uncertainty when screening for serious pathology in 40% (10/25) of cases. Pharmacists requested more direction from the CDSS in relation to automated prompts for user input and page navigation. Overall system usability was rated as “excellent” (mean score = 92/100, SD = 6.5, 90th percentile compared to similar systems); with acceptance rated as “good” to “excellent”.
Conclusions:
A novel CDSS (high-fidelity prototype) to enhance pharmacist care of LBP was developed, underpinned by clinical practice guidelines and informed by a multi-disciplinary team of experts. User-testing revealed a high level of usability and acceptance of the prototype system, with suggestions to improve interface prompts and information delivery.
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