Background: Clinical decision support systems (CDSS) can modify clinician behaviour, yet the factors influencing\ntheir effect remain poorly understood. This study assesses the feasibility and acceptability of a CDSS supporting\ndiagnostic and treatment decisions for patients with suspected stable angina.\nMethods: Intervention The Optimising Management of Angina (OMA) programme includes a CDSS guiding\ninvestigation and medication decisions for clinicians managing patients with new onset stable angina, based on\nEnglish national guidelines, introduced through an educational intervention. Design and participants A mixed\nmethods study i. A study of outcomes among patients presenting with suspected angina in three chest pain clinics\nin England before and after introduction of the OMA programme. ii. Observations of clinic processes, interviews and\na focus group with health professionals at two chest pain clinics after delivery of the OMA programme. Outcomes.\nMedication and cardiovascular imaging investigations undertaken within six months of presentation, and\nconcordance of these with the recommendations of the CDSS. Thematic analysis of qualitative data to understand\nhow the CDSS was used.\nResults: Data were analysed for 285 patients attending chest pain clinics: 106 before and 179 after delivery of the\nOMA programme. 40 consultations were observed, 5 clinicians interviewed, and a focus group held after the\nintervention. The proportion of patients appropriate for diagnostic investigation who received one was 50 %\n(95 CI 34ââ?¬â??66 %) of those before OMA and 59 % (95 CI 48ââ?¬â??70 %) of those after OMA. Despite high use of the CDSS\n(84 % of consultations), observations and interviews revealed difficulty with data entry into the CDSS, and structural\nand practical barriers to its use. In the majority of cases the CDSS was not used to guide real-time decision making,\nonly being consulted after the patient had left the room.\nConclusions: The OMA CDSS for the management of chest pain is not feasible in its current form. The CDSS was\nnot used to support decisions about the care of individual patients. A range of barriers to the use of the CDSS were\nidentified, some are easily removed, such as insufficient capture of cardiovascular risk, while others are more deeply\nembedded in current practice, such as unavailability of some investigations or no prescribing privileges for nurses.
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