title: Exposure to and experiences with a computerized decision support intervention in primary care: results from a process evaluation.
abstract: 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.
  
  
  BACKGROUND
  Clinical trials NCT01773057 .
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. dennis.pasveer@radboudumc.nl.
authors.forename: Dennis
authors.initials: D
authors.lastname: Pasveer
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. trudy.vanderweijden@maastrichtuniversity.nl.
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. gert.westert@radboudumc.nl.
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. tijn.kool@radboudumc.nl.
authors.forename: Rudolf B
authors.initials: RB
authors.lastname: Kool
mesh_terms: D001291:Attitude of Health Personnel; D020000:Decision Support Systems, Clinical; D005260:Female; D058005:General Practitioners; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D009726:Nurses; D011320:Primary Health Care / Q000379:methods*; D015397:Program Evaluation; D011795:Surveys and Questionnaires