title: Perceived barriers of heart failure nurses and cardiologists in using clinical decision support systems in the treatment of heart failure patients.
abstract: BACKGROUND
  Clinical Decision Support Systems (CDSSs) can support guideline adherence in heart failure (HF) patients. However, the use of CDSSs is limited and barriers in working with CDSSs have been described as a major obstacle. It is unknown if barriers to CDSSs are present and differ between HF nurses and cardiologists. Therefore the aims of this study are; 1. Explore the type and number of perceived barriers of HF nurses and cardiologists to use a CDSS in the treatment of HF patients. 2. Explore possible differences in perceived barriers between two groups. 3. Assess the relevance and influence of knowledge management (KM) on Responsibility/Trust (R&T) and Barriers/Threats (B&T).
  
  
  METHODS
  A questionnaire was developed including; B&T, R&T, and KM. For analyses, descriptive techniques, 2-tailed Pearson correlation tests, and multiple regression analyses were performed.
  
  
  RESULTS
  The response- rate of 220 questionnaires was 74%. Barriers were found for cardiologists and HF nurses in all the constructs. Sixty-five percent did not want to be dependent on a CDSS. Nevertheless thirty-six percent of HF nurses and 50% of cardiologists stated that a CDSS can optimize HF medication. No relationship between constructs and age; gender; years of work experience; general computer experience and email/internet were observed. In the group of HF nurses a positive correlation (r .33, P<.01) between years of using the internet and R&T was found. In both groups KM was associated with the constructs B&T (B=.55, P=<.01) and R&T (B=.50, P=<.01).
  
  
  CONCLUSIONS
  Both cardiologists and HF-nurses perceived barriers in working with a CDSS in all of the examined constructs. KM has a strong positive correlation with perceived barriers, indicating that increasing knowledge about CDSSs can decrease their barriers.
authors.affiliation: Department of Cardiology, University Medical Centre Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands. a.e.de.vries@umcg.nl
authors.forename: Arjen E
authors.initials: AE
authors.lastname: de Vries
authors.forename: Martje H L
authors.initials: MH
authors.lastname: van der Wal
authors.forename: Maurice M W
authors.initials: MM
authors.lastname: Nieuwenhuis
authors.forename: Richard M
authors.initials: RM
authors.lastname: de Jong
authors.forename: Rene B
authors.initials: RB
authors.lastname: van Dijk
authors.forename: Tiny
authors.initials: T
authors.lastname: Jaarsma
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Rene J
authors.initials: RJ
authors.lastname: Jorna
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002309:Cardiology; D002983:Clinical Competence; D003201:Computers / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000592:standards*; D006333:Heart Failure / Q000451:nursing / Q000628:therapy*; D006801:Humans; D058436:Knowledge Management; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D012307:Risk Factors; D012941:Social Responsibility; D013041:Specialties, Nursing; D011795:Surveys and Questionnaires; D000078329:Workforce