Testing CDS in OSCAR EMR Using STOPP Criteria

NCT02130895 | Completed

• 1 other identifier: H14-00797
• Study Type: interventional
• Target: 28
• Locations: 1 country
• Sites: 1

Brief Summary

This mixed methods study seeks to assess and understand the impact of using an advanced CDS tool to present the STOPP criteria to support prescribers at the point of decision-making. We ask the overarching question: \*\*How can clinical decision support tools effectively translate a complex set of evidence-based rules into primary care clinical practice?\*\* The work is divided into 2 phases. PHASE 1: Randomized control trial. We will measure change in potentially inappropriate prescribing by primary care prescribers (e.g. family doctors) who are using the Clinical Decision Support (CDS) tool in their Electronic Medical Record (EMR), as compared to those who are not. Potentially Inappropriate Prescribing is defined by the STOPP criteria, the same criteria that will be used in the clinical decision support tool in the EMR. We will use the OSCAR EMR for this study. EMR based queries will be developed to assess the number of potentially inappropriate prescriptions are current in each of 12 physician practices at baseline and at 16 weeks. PHASE 2: We will then complete a qualitative follow up with participants to aid in understanding how primary care prescribers perceived the CDS. This will help explain Phase 1 findings and provide additional information to enhance future decision support tools.

Conditions

Prescribing

Keywords

prescribing; STOPP Criteria; potentially inappropriate prescribing; clinical decision support; Electronic Medical Records; primary care

Outcome Measures

Primary Outcomes (1)

• Change in rate of potentially inappropriate prescribing

  Reports will be run on EMR data to provide summary statistics to count rates for potentially inappropriate prescriptions. The reports will be generated using a series of queries that are consistent with the rules that trigger the CDS alerts. Change will be determined between baseline and 8 weeks and baseline and 16 weeks.

  Baseline, 8 weeks, 16 weeks

Secondary Outcomes (2)

• Change in rates of Potentially Inappropriate Prescribing for Individual STOPP Criteria

  16 weeks

• Qualitative User Assessment of Decision Support

  Point in Time after intervention

Study Arms (2)

Intervention

EXPERIMENTAL

STOPP Criteria Decision Support Content Intervention arm will receive CDS suggestions based on the STOPP criteria.

Other: STOPP Criteria Decision Support Content

Control

NO INTERVENTION

Control arm will provide care as usual during the intervention period.

Interventions

STOPP Criteria Decision Support Content OTHER

55 previously developed clinical decision support suggestions based on the STOPP criteria will be activated in the physician EMR. Each suggestion provides a patient specific rule that, if triggered will display its title in an existing "Clinical Decision Alerts" box on the bottom right hand column in the patient's EMR chart. For example, in a patient with diabetes and on a beta blocker then the suggestion "Consider: avoiding b-blockers in elderly diabetics with \>=1 hypoglycaemic episodes / month" will be presented to the physician in the side bar (not a popup). The physician then can decide to review, consider, or ignore the recommendation.

Intervention

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• Have been using the OSCAR EMR v 12.x for \>12 months (to provide enough time for medications to be consistently documented in the EMR).
• Have OSCAR EMR installed locally in the practice.
• Agree to be or are already a part of the University of British Columbia's Department of Family Practice's (UBC DFP) research network.
• Ensure their OSCAR Service Provider (OSP) agrees to support the research network hardware/software installation.
• Have not used the STOPP criteria in OSCAR prior to the study.

You may not qualify if:

• Non-prescribers.
• Those who do not provide longitudinal care (e.g. walk-in clinics).
• Specialists or midwives.
• Those who do not have regular patients over age 64 (e.g. maternity clinics).
• Those who do not use OSCAR 12.1 or those that do not document prescriptions in their EMR prescription module.
• Those who have ALREADY used the STOPP rules in OSCAR prior to the study.

Sponsors & Collaborators

• University of British Columbia: lead
• Canadian Institutes of Health Research (CIHR): collaborator

Study Sites (1)

Private Physician Offices

Multiple Expected, British Columbia, Canada

Location

Related Publications (1)

• Price M, Davies I, Rusk R, Lesperance M, Weber J. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality. JMIR Med Inform. 2017 Jun 15;5(2):e15. doi: 10.2196/medinform.6226.

  PMID: 28619704 DERIVED

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor

Study Record Dates

• First Submitted: May 1, 2014
• First Posted: May 6, 2014
• Study Start: October 1, 2014
• Primary Completion: October 1, 2015
• Study Completion: October 1, 2015
• Last Updated: December 3, 2015

Record last verified: 2015-12

Locations

CA (1)