Effectiveness of interactive dashboards to optimise prescribing in primary care: a protocol for a systematic review

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Abstract

Introduction

Advances in therapeutics and healthcare have led to a growing population of older people living with multimorbidity and polypharmacy making prescribing more challenging. Most prescribing occurs in primary care and General Practitioners (GPs) have expressed interest in comparative feedback on their prescribing performance. Clinical decision support systems (CDSS) and audit and feedback interventions have shown some impact, but changes are often short-lived. Interactive dashboards, a novel approach integrating CDSS and audit and feedback elements, offer longitudinal updated data outside clinical encounters. This systematic review aims to explore the effectiveness of interactive dashboards on prescribing-related outcomes in primary care and examine the characteristics of these dashboards.

Methods

This protocol was prospectively registered on PROSPERO (CRD42023481475) and reported in line with PRISMA-P guidelines. Searches of PubMed, EMBASE, Medline, PsychINFO, CINAHL, Scopus, the Cochrane Library, and grey literature, including trial registries were performed to identify interventional studies (randomised and non-randomised) that assess the effectiveness of interactive dashboards on prescribing related outcomes. The search will be supplemented by searching references of retrieved articles with the use of an automated citation chaser. Identified records will be screened independently by two reviewers and data from eligible studies extracted using a purposely developed data extraction tool. We will narratively summarise the intervention types and those associated with improvements in prescribing outcomes. A quantitative synthesis will be carried out if a sufficient number of homogenous studies are identified. Methodological quality will be assessed by two reviewers using the Cochrane Effective Practice and Organisation of Care risk assessment tool.

Discussion

This systematic review will explore the effect of interactive dashboards on prescribing related outcome measures in primary care and describe the characteristics of interactive dashboards. This research may inform future intervention development and shape policymaking particularly in the context of ongoing and planned developments in e-prescribing infrastructure.

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Most cited references 37

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Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement

David Moher, Larissa Shamseer, Mike Clarke … (2017)

Systematic reviews should build on a protocol that describes the rationale, hypothesis, and planned methods of the review; few reviews report whether a protocol exists. Detailed, well-described protocols can facilitate the understanding and appraisal of the review methods, as well as the detection of modifications to methods and selective reporting in completed reviews. We describe the development of a reporting guideline, the Preferred Reporting Items for Systematic reviews and Meta-Analyses for Protocols 2015 (PRISMA-P 2015). PRISMA-P consists of a 17-item checklist intended to facilitate the preparation and reporting of a robust protocol for the systematic review. Funders and those commissioning reviews might consider mandating the use of the checklist to facilitate the submission of relevant protocol information in funding applications. Similarly, peer reviewers and editors can use the guidance to gauge the completeness and transparency of a systematic review protocol submitted for publication in a journal or other medium.

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Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

T C Hoffmann, P P Glasziou, I Boutron … (2015)

Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.

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Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review.

Amit X Garg, Neill K. J. Adhikari, Heather McDonald … (2005)

Developers of health care software have attributed improvements in patient care to these applications. As with any health care intervention, such claims require confirmation in clinical trials. To review controlled trials assessing the effects of computerized clinical decision support systems (CDSSs) and to identify study characteristics predicting benefit. We updated our earlier reviews by searching the MEDLINE, EMBASE, Cochrane Library, Inspec, and ISI databases and consulting reference lists through September 2004. Authors of 64 primary studies confirmed data or provided additional information. We included randomized and nonrandomized controlled trials that evaluated the effect of a CDSS compared with care provided without a CDSS on practitioner performance or patient outcomes. Teams of 2 reviewers independently abstracted data on methods, setting, CDSS and patient characteristics, and outcomes. One hundred studies met our inclusion criteria. The number and methodologic quality of studies improved over time. The CDSS improved practitioner performance in 62 (64%) of the 97 studies assessing this outcome, including 4 (40%) of 10 diagnostic systems, 16 (76%) of 21 reminder systems, 23 (62%) of 37 disease management systems, and 19 (66%) of 29 drug-dosing or prescribing systems. Fifty-two trials assessed 1 or more patient outcomes, of which 7 trials (13%) reported improvements. Improved practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system (success in 73% of trials vs 47%; P = .02) and studies in which the authors also developed the CDSS software compared with studies in which the authors were not the developers (74% success vs 28%; respectively, P = .001). Many CDSSs improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent.

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Author and article information

Contributors

Patrick Moynagh: Role: ConceptualizationRole: MethodologyRole: Project AdministrationRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0009-0004-1233-3176

Áine Mannion: Role: Writing – Review & Editing

Ashley Wei: Role: Writing – Review & Editing

Barbara Clyne: Role: MethodologyRole: Writing – Review & Editing

Frank Moriarty: Role: MethodologyRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0001-9838-3625

Caroline McCarthy: Role: ConceptualizationRole: Funding AcquisitionRole: MethodologyRole: Project AdministrationRole: SupervisionRole: VisualizationRole: Writing – Original Draft PreparationRole: Writing – Review & Editing

ORCID: https://orcid.org/0000-0002-2986-5994

Journal

Journal ID (nlm-ta): HRB Open Res

Journal ID (iso-abbrev): HRB Open Res

Title: HRB Open Research

Publisher: F1000 Research Limited (London, UK )

ISSN (Electronic): 2515-4826

Publication date (Electronic): 3 July 2024

Publication date Collection: 2024

Volume: 7

Electronic Location Identifier: 44

Affiliations

[1 ]Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland

[2 ]Department of Public Health & Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland

[3 ]School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland

[1 ]University of Lausanne, Lausanne, Switzerland

[1 ]University of Galway, Galway, Ireland

[1 ]University College Cork, Cork, Ireland

[1 ]The University of Dodoma, Dodoma, Dodoma Region, Tanzania

Author notes

[a ] patrickmoynagh@ 123456rcsi.ie

No competing interests were disclosed.

Competing interests: No competing interests were disclosed.

Author information

Patrick Moynagh https://orcid.org/0009-0004-1233-3176

Frank Moriarty https://orcid.org/0000-0001-9838-3625

Caroline McCarthy https://orcid.org/0000-0002-2986-5994

Article

DOI: 10.12688/hrbopenres.13909.1

PMC ID: 11808840

PubMed ID: 39931386

SO-VID: 75dcf21c-f8a3-43b1-949d-b65e58766404

License:

This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date accepted : 25 June 2024

Funding

Funded by: Health Research Board

Award ID: CSF-2023-012

Funded by: Irish College of General Practitioners

PM is funded by an ICGP Post CSCST Fellowship award. CMC is funded by a HRB Clinician Scientist Fellowship Award (CSF- 2023-012).

The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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