Clinical decision support system for assessment and management of breathlessness in primary care

Research question In patients presenting with persistent or recurrent breathlessness in the primary care setting, what is the effect of Clinical Decision Support Systems (CDSS) compared with usual care on important clinical outcomes? BackgroundDiagnosing the cause of breathlessness can be difficult due to the myriad of possible etiologies ranging from pulmonary to cardiac, metabolic diseases and deconditioning. In the primarycare setting, a previous study of patients referred for breathlessness reported that less than 30% had a fully concordant referral diagnosis with the final diagnosis. Furthermore, there has been a growing abundance of disease-specific guidelines. However, studies indicate that they are frequently not applied resulting in unnecessary diagnostics and even inadequate or potentially harmful treatments prescribed. CDSSs which help guide history taking, clinical reasoning and management would potentially be useful in addressing these gaps in care. Possible methodologyA systematic literature review is being conducted to evaluate the effect of CDSS in primary care on important health outcomes, patients’ and providers’ (physicians and associated primary care staff) acceptability and satisfaction, providers’ adherence to CDSS recommendations, economic impact, resource use, and unintended consequences. This review would be a basis for the development and trial of such a computerised CDSS for Breathlessness in primary care practices, integrated with current GP software and electronic health records systems. Questions to discussResearch issues to explore include - identifying the key health outcomes to evaluate the impact of CDSS interventions for breathlessness and and selecting one to be the primary outcome of the trial; classifying the various types of CDSS systems in previous studies; developing and validating a practical algorithm for use in primary care; best approach to conducting such implementation trials in primary care; and evaluating the impact on resources and unintended consequences of CDSS implementation. Declaration of Interest The conduct of this study was funded by a Sydney Partnership for Health, Education, Research and Enterprise (SPHERE) grant. References and Clinical Trial Registry Information