چکیده (انگلیسی):

Background:Trials evaluating the effects of interventions usually provide little insight into the factors responsible
for (lack of) changes in desired outcomes. A process evaluation alongside a trial can shed light on the mechanisms
responsible for the outcomes of a trial. The aim of this study was to investigate exposure to and experiences with a
computerized decision support system (CDSS) intervention, in order to gain insight into the intervention’s impact
and to provide suggestions for improvement.
Methods:A process evaluation was conducted as part of a large-scale cluster-randomized controlled trial
investigating the effects of the CDSS NHGDoc on quality of care. Data on exposure to and experiences with the
intervention were collected during the trial period among participants in both the intervention and control
group - whenever applicable - by means of the NHGDoc server and an electronic questionnaire. Multiple data
were analyzed using descriptive statistics.
Results:Ninety-nine percent (n= 229) of the included practices generated data for the NHGDoc server and 50 %
(n= 116) responded to the questionnaire: both general practitioners (GPs;n= 112; 49 %) and practice nurses (PNs;
n= 52; 37 %) participated. The actual exposure to the NHGDoc system and specific heart failure module was limited
with 52 % of the GPs and 42 % of the PNs reporting to either never or rarely use the system. Overall, users had a
positive attitude towards CDSSs. The most perceived barriers to using NHGDoc were a lack of learning capacity of
the system, the additional time and work it requires to use the CDSS, irrelevant alerts, too high intensity of alerts
and insufficient knowledge regarding the system.
Conclusions:Several types of barriers may have negatively affected the impact of the intervention. Although users
are generally positive about CDSSs, a large share of them is insufficiently aware of the functions of NHGDoc and,
finds the decision support not always useful or relevant and difficult to integrate into daily practice. In designing
CDSS interventions we suggest to more intensely involve the end-users and increase the system’s flexibility and
learning capacity. To improve implementation a proper introduction of a CDSS among its target group including
adequate training is advocated.
Trial registration:Clinical trials NCT01773057.