title: To test or not: a registry-based observational study of an online decision support for prostate-specific antigen tests.
abstract: BACKGROUND
  Watchful waiting is an essential part in the handling of patients with prostate cancer (PC). More effective disease management may be achieved by this strategy. Correct use of prostate-specific antigen (PSA) test is crucial and the general practitioner (GP) may therefore benefit from access to a clinical decision support system (CDSS) that focuses on this challenge. There are many barriers to the use of CDSSs. The aim of the present paper is to study if such barriers may be overcome by granting GPs easier access to a web-based CDSS via a hyperlink in the GPs' electronic medical record system (EMR).
  
  
  METHODS
  In the present population-based observational registry study with an intervention and control group, we created a web-based CDSS that was made accessible to GPs via hyperlink inserted into the EMR medical chart contents. The intervention was introduced 1 January 2011. Our outcome measure was the number of age-standardised PSA test rates per 1000 men per practice during three equally sized periods of 6 months within the study period from 1 January 2010 to 30 June 2011.
  
  
  RESULTS
  We found that none of the differences between intervention and control groups were statistically significant.
  
  
  CONCLUSIONS
  Providing GPs with access to a CDSS to aid their decision to use the PSA, had no measurable effect on the GPs' PSA testing behaviour.
authors.affiliation: The Research Unit for General Practice, School of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Section for General Medical Practice, School of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Centre for Cancer Diagnosis in Primary Care - CaP, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: mukai@alm.au.dk.
authors.forename: Thomas Ostersen
authors.initials: TO
authors.lastname: Mukai
authors.affiliation: The Research Unit for General Practice, School of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: fbro@alm.au.dk.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bro
authors.affiliation: The Research Unit for General Practice, School of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: fo@alm.au.dk.
authors.forename: Frede
authors.initials: F
authors.lastname: Olesen
authors.affiliation: The Research Unit for General Practice, School of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark; Research Centre for Cancer Diagnosis in Primary Care - CaP, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark. Electronic address: p.vedsted@alm.au.dk.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D003718:Denmark / Q000453:epidemiology; D057286:Electronic Health Records / Q000706:statistics & numerical data; D058006:General Practice / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009862:Online Systems; D015995:Prevalence; D017430:Prostate-Specific Antigen / Q000097:blood*; D011471:Prostatic Neoplasms / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D012042:Registries; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014600:Utilization Review
chemical_list: D014408:Biomarkers, Tumor; D017430:Prostate-Specific Antigen
keywords: CDSS; EMR; PSA-testing; Prostate cancer