title: Implementation of multiple-domain covering computerized decision support systems in primary care: a focus group study on perceived barriers.
abstract: BACKGROUND
  Despite the widespread availability of computerized decision support systems (CDSSs) in various healthcare settings, evidence on their uptake and effectiveness is still limited. Most barrier studies focus on CDSSs that are aimed at a limited number of decision points within selected small-scale academic settings. The aim of this study was to identify the perceived barriers to using large-scale implemented CDSSs covering multiple disease areas in primary care.
  
  
  METHODS
  Three focus group sessions were conducted in which 24 primary care practitioners (PCPs) participated (general practitioners, general practitioners in training and practice nurses), varying from 7 to 9 per session. In each focus group, barriers to using CDSSs were discussed using a semi-structured literature-based topic list. Focus group discussions were audio-taped and transcribed verbatim. Two researchers independently performed thematic content analysis using the software program Atlas.ti 7.0.
  
  
  RESULTS
  Three groups of barriers emerged, related to 1) the users' knowledge of the system, 2) the users' evaluation of features of the system (source and content, format/lay out, and functionality), and 3) the interaction of the system with external factors (patient-related and environmental factors). Commonly perceived barriers were insufficient knowledge of the CDSS, irrelevant alerts, too high intensity of alerts, a lack of flexibility and learning capacity of the CDSS, a negative effect on patient communication, and the additional time and work it requires to use the CDSS.
  
  
  CONCLUSIONS
  Multiple types of barriers may hinder the use of large-scale implemented CDSSs covering multiple disease areas in primary care. Lack of knowledge of the system is an important barrier, emphasizing the importance of a proper introduction of the system to the target group. Furthermore, barriers related to a lack of integration into daily practice seem to be of primary concern, suggesting that increasing the system's flexibility and learning capacity in order to be able to adapt the decision support to meet the varying needs of different users should be the main target of CDSS interventions.
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. m.lugtenberg@tilburguniversity.edu.|Scientific center for care and welfare (Tranzo), Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands. m.lugtenberg@tilburguniversity.edu.
authors.forename: Marjolein
authors.initials: M
authors.lastname: Lugtenberg
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Jan-Willem
authors.initials: JW
authors.lastname: Weenink
authors.affiliation: School for Public Health and Primary Care (CAPHRI), Department of General Practice, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
authors.forename: Trudy
authors.initials: T
authors.lastname: van der Weijden
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Gert P
authors.initials: GP
authors.lastname: Westert
authors.affiliation: Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud university medical center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
authors.forename: Rudolf B
authors.initials: RB
authors.lastname: Kool
mesh_terms: D000328:Adult; D020000:Decision Support Systems, Clinical / Q000706:statistics & numerical data*; D005260:Female; D017144:Focus Groups; D058005:General Practitioners / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*