The acceptability of an asthma diagnosis clinical decision support system to primary care clinicians

Background: Mis-diagnosis of asthma is common. There is uncertainty about how best to diagnose asthma in primary care, and variability in how clinicians weigh up the likelihood of asthma. To address this, we developed a prototype clinical decision support system (CDSS) which integrates with electronic health records in primary care. The CDSS calculates the probability of an asthma diagnosis in children and young people (≤25 years) and suggests the steps needed to confirm or refute a diagnosis (Figure 1). We aimed to 1) evaluate CDSS usage within GP practices during a 6-month feasibility study. 2) understand the acceptability and usability of the CDSS to clinicians. Methods: General practices were recruited from England and Scotland. Following a training session, the CDSS was installed in each practice and available for use during routine consultations for up to six months. Usage of the CDSS was analysed. Toward the end of the study, clinicians who had used the CDSS were invited to take part in a qualitative interview which were audio-recorded, transcribed and analysed thematically. Results: Within the 12 practices recruited, the CDSS was used by 76 clinicians and the probability of asthma diagnosis calculated 185 times. 11 clinicians (8 nurses and 3 GPs) from eight practices were interviewed. The CDSS was acceptable to participants who particularly commented on the ease of use, auto-population of information from the patient record, the presentation of the probability score and resources for patients being embedded in the software. Downsides included the inability to record findings directly into the patient notes and a sense that whilst useful for trainees and junior colleagues, the CDSS would not necessarily lead to a change in their own practice. Conclusions: The CDSS was generally well received by primary care clinicians, yet participants felt it would be most useful for less experienced colleagues.