A primary care clinical decision support system (CDSS) for asthma diagnosis: what do clinicians want?

Background Misdiagnosis of asthma is common in routine general practice. An asthma CDSS has the potential to facilitate best practice by achieving a more robust diagnosis, promoting phenotyping of individuals with newly diagnosed asthma and, by including a patient-facing mode, could enable information to be shared between patients and clinicians. AimTo explore the perspectives of primary care clinicians on the design and content of an asthma CDSS and to understand how it could usefully be implemented in UK primary care.MethodsWe recruited primary care clinicians (GPs and nurses) with a range of duration of professional experience in UK general practices covering urban/rural and socio-economically deprived/affluent areas. Semi-structured interviews addressed clinicians’ views on challenges in diagnosing asthma, asthma risk factors, barriers and facilitators to routinely using a CDSS and the design and content of the CDSS. Interviews were audio-recorded, transcribed verbatim and analysed thematically. ResultsWe recruited nine GPs and seven nurses. Key emergent themes were (i) asthma can be difficult to diagnose, frequently requiring several months of assessments which can be frustrating for patients; (ii) to be feasible/acceptable, and ensure routine use, an asthma CDSS must be easy to access, simple to use, not time-consuming, and linked to current software on NHS computers; (iii) especially helpful was the inclusion of identifiable asthma risk factors within the proposed algorithm; (iv) a CDSS with a patient-facing mode could encourage screen-sharing, promote involvement in the diagnostic process, patient engagement and supported self-management. ConclusionClinicians welcomed the potential introduction of an asthma CDSS. The ability of the CDSS to auto-populate information from a patient’s electronic health record, including the presence of risk factors for asthma diagnosis, were especially valued. We are currently interviewing asthma patients and will be conducting a feasibility study of the CDSS in UK general practices later this year. Implementation Science/Service Development Research Ideas on Respiratory Conditions and Tobacco Dependency Abstract Declaration of Interest Asthma UK/Innovate UK: AUK-PG-2018-404LD is supported by a CSO Clinical Academic Fellowship (CAF/17/01) COI: Nil. References and Clinical Trial Registry Information