Zusammenfassung
Hintergrund
Elektronische Entscheidungshilfen (EE) haben das Potenzial, die Behandlungsqualität
des Chronic Disease Managements (CDM) und damit patient*innenrelevante Outcomes zu
verbessern. Allerdings sind EE in der Primärversorgung von Patient*innen mit COPD
kaum implementiert. Die Ziele dieser Pilotstudie waren die Entwicklung und die Implementierung
einer EE für das CDM von COPD in zwei schweizerischen Hausarztpraxen.
Methode
Zwei Hausarztpraxen mit jeweils fünf Hausärzt*innen und ihren medizinischen Praxisassistent*innen
(MPA) und medizinischen Praxiskoordinator*innen (MPK) nahmen an der Studie teil. Die
EE wurde in Zusammenarbeit mit der ersten der beiden Hausarztpraxen (Praxis 1) entwickelt
– nach dem Prinzip eines Entwicklungszyklus mit Alpha- und Beta-Test. Die Langzeittestung
über ein Jahr erfolgte in beiden Hausarztpraxen. Evaluiert wurde die Implementierung
nach dem RE-AIM Framework: Reach: Anzahl der mit der EE ins CDM eingeschlossenen Patient*innen, Effectiveness: Anzahl der mit der EE initiierten Behandlungsprozesse pro Patient*in, Adoption: Nutzungsprofile der EE-Funktionen in den Praxen, Implementation und Maintenance: Ansichten der Praxismitarbeiter*innen hinsichtlich der Auswirkungen der EE auf die
Behandlungsqualität und die Bereitschaft, die EE nach der Langzeittestung weiterzuverwenden.
Die Daten wurden in der EE selbst erhoben – durch Tracking der Nutzerdaten sowie durch
Fragebögen unter den Praxismitarbeiter*innen.
Ergebnisse
Reach: Nach der Langzeittestung betrug die Anzahl der in der EE erfassten Patient*innen
28 in Praxis 1 und 12 in Praxis 2. Effectiveness: Die Anzahl der in der EE initiierten Behandlungsprozesse pro Patient*in betrug 14
(IQR 6 bis 22) in Praxis 1 und 6 (IQR 5 bis 8) in Praxis 2. Adoption: Die Nutzungsprofile der EE unterschieden sich stark zwischen den Praxen. Implementation und Maintenance: Nach der Langzeittestung waren die Befragten kritischer gegenüber der Behandlungsqualität
des CDM bei Patient*innen mit COPD in der Praxis, und interprofessionelle Vorstellungen
über die Behandlung von Patient*innen mit COPD wurden häufiger vertreten als vor der
Langzeittestung. Die Befragten waren optimistisch gegenüber dem Potenzial der EE,
die Behandlungsqualität zu verbessern, und nach der Langzeittestung weiterhin motiviert,
die EE zu verwenden.
Schlussfolgerung
Diese Pilotstudie bereitet den Weg für zukünftige Projekte mit dem Ziel, EE für das
CDM bei COPD in der Primärversorgung zu entwickeln und zu implementieren. Zukünftige
größere Implementierungsstudien in diesem Gebiet sollten größeren Wert auf die Messung
von strukturellen Merkmalen der Praxen sowie auf patient*innenrelevante Outcomes legen.
Die modifizierbaren Praxismerkmale sollten dann in randomisierten Studien auf ihre
Wirkung auf patient*innenrelevante Outcomes getestet werden.
Abstract
Background
Electronic clinical decision aids (eCDAs) have the potential to improve the quality
of chronic disease management (CDM) and; therefore, patient relevant outcomes. However,
eCDAs are only sparsely implemented in primary care for chronic obstructive pulmonary
disease (COPD). The aim of this pilot study was to develop and implement of an eCDA
for COPD primary care in two Swiss primary care practices.
Method
Two primary care practices, each with five primary care physicians and their assistants
participated in the study. The eCDA was developed in collaboration with one of the
two GP practices (Practice 1) following a development cycle encompassing alpha- and
beta-testing stages. Long-term testing for one year was conducted in both practices.
The implementation of the eCDA was evaluated according to the RE-AIM framework counting
occurrences as follows: Reach: the number of patients included in the CDM using the eCDA. Effectiveness: the number of treatment processes initiated per patient. Adoption: practice utilization of the diverse functions featured in the eCDA. Implementation and Maintenance: health care professionals’ attitudes towards the impact of the eCDA on the quality
of care and their willingness to continue using the eCDA after long-term testing.
Data were collected by the eCDA itself, which was programmed to track user data, and
from practice staff using questionnaires.
Results
Reach: After the long-term test, the number of patients recorded in the eCDA was 28 in
practice 1, and 12 in practice 2. Effectiveness: The number of evidence-based treatment processes per patient was 14 (IQR 6 to 22)
in Practice 1 and 6 (IQR 5 to 8) in Practice 2. Adoption: The utilization profiles of the eCDA differed greatly between practices. Implementation and Maintenance: After the long-term test, respondents were more critical of the quality of the CDM
for patients with COPD, and attitudes consistent with interprofessional care were
more prevalent compared to baseline. Respondents were optimistic regarding both the
potential of the eCDA to improve the quality of CDM and their motivation to continue
using the eCDA after long-term testing.
Conclusion
This pilot study is a roadmap for future projects aiming to develop and implement
eCDAs for the CDM of COPD in primary care. Future larger implementation studies in
this domain should place greater emphasis on the measurement of structural practice
characteristics as potential determinants of patient-relevant outcomes. The modifiable
determinants should then be tested for their effects on patient-relevant outcomes
in a randomized controlled design.
Schlüsselwörter
Keywords
Abkürzungen:
COPD (chronisch obstruktive Lungenerkrankung), CMD (Chronic Disease Management), EE (elektronische Enscheidungshilfe), FEV1 (Einsekundenkapazität), MPA (medizinische*r Praxisassistent*in), MPK (medizinische*r Praxiskoordinator*in)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 03, 2023
Accepted:
November 28,
2022
Received in revised form:
November 21,
2022
Received:
July 13,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2023 Published by Elsevier GmbH.
