Influence of the use of a tablet-based clinical decision support algorithm by general practitioners on the consultation process: the example of FeverTravelApp

Abstract

Abstract Aims of the study Despite proven positive effects on general practitioners’ (GPs) performance and on the management of patients and treatments, adoption of clinical decision support systems (CDSSs) is slow. Several elements have been put forward to explain this reluctance of GPs to adopt these tools. We hypothesise that their influence on patient-physician interaction could play a determining role. We use the case of FeverTravelApp, an App created to help general practitioners manage patients with fever upon return from the tropics.Methods We conducted a case-control study by observing and analysing fourteen consultations between seven physicians - using or not the FeverTravelApp - and three simulated patients. Each consultation was video-recorded and analysed using an analysis grid created for the study based on 3 existing tools. To our knowledge, there is no tool that can sufficiently capture the influence of an App on the consultation. After each consultation, simulated patients had to complete the Communication Assessment Tool (CAT), a validated tool for the evaluation of physicians' communication skills by their patients. Finally, each physician underwent a semi-structured interview after using the App. Every physician and simulated patient gave their written informed consent to participate in the study.Results The use of the App influenced many aspects of the consultation, particularly at the level of communication. While using the App, both patients’ and GPs’ talking time decreased and active silence (no one talking while the GP actively performs a task) increased. The GPs tended to watch the App at the expense of the time spent gazing at their patient. However, this strong influence at this level seemed to bother the GPs more than the simulated patients who rated their GP equally when the latter was using the App. This could be explained by the fact that the patients felt better understood by their GP who asked less questions but more specific to a travel medicine consultation and seemed, as a consequence, to understand their problem better.Conclusions This study supports the hypothesis that the influence of CDSS on consultation plays a determining role in the difficulty of their implementation. Clinicians should be included as early as possible in the development of the CDSS in order to adapt it to their clinical habits, but also to ensure interoperability of the systems to avoid administrative duplication. In addition, it seems that a tool which allows the clinician to follow the whole clinical reasoning is needed. This could for example take the form of a decision tree. Further research is needed to confirm our findings when CDSSs are used to manage real patients, the ultimate goal being to create CDSSs that are in line with both patients’ and GPs’ expectations.