Barriers and facilitators to a health information exchange system between general practitioners and hospitals: a qualitative study in Southern Switzerland.

BACKGROUND: Health information exchange (HIE) systems are computer tools that healthcare providers use to share patients' medical information electronically. Our study aimed to identify barriers and facilitators perceived by general practitioners (GPs) when using an HIE system in the Canton of Ticino, a region in southern Switzerland. METHODS: We performed a qualitative study using semi-structured interviews. Ten GPs participated in the study. We analysed transcripts using thematic content analysis and following an abductive approach (a mix of deductive and inductive approaches). RESULTS: Our findings indicate the following main facilitators of the HIE system: (a) the perception of having to do with a secure system; (b) the possibility of delegating its management to secretaries and healthcare assistants; (c) technical support and training; (d) high quality of the information exchanged; (e) positive impact on clinical practice; and (f) regional context. However, major challenges still persist, and GPs reported the following main barriers to using an HIE system: (a) a frequent lack of all the patient documentation they needed; (b) no effective workflow improvements; and (c) lack of some technical features. CONCLUSIONS: The results of our study provide a qualitative perspective of opinions and experiences of GPs that can inform improvements of the current HIE system and future federal and cantonal HIE initiatives in Switzerland and elsewhere

Factors determining the adherence to antimicrobial guidelines and the adoption of computerised decision support systems by physicians: A qualitative study in three European hospitals

Antimicrobial stewardship (AMS) programs aim to optimize antibiotic use and reduce inappropriate prescriptions through a panel of interventions. The implementation of clinical guidelines is a core strategy of AMS programs. Nevertheless, their dissemination and application remain low. Computerised decision support systems (CDSSs) offer new opportunities for semi-automated dissemination of guidelines. This qualitative study aimed at gaining an in-depth understanding of the determinants of adherence to antimicrobial prescribing guidelines and CDSSs adoption and is part of a larger project, the COMPASS trial, which aims to assess a CDSS for antimicrobial prescription. The final objective of this qualitative study is to 1) provide insights from end-users to assist in the design of the COMPASS CDSS, and to 2) help with the interpretation of the quantitative findings of the randomised controlled trial assessing the COMPASS CDSS, once data will be analysed

Triadic partnerships: Evaluation of a group mentorship scheme

We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) in our pilot mentorship scheme within a distance learning MSc, evaluated the scheme, and developed a conceptual model of “triadic partnerships.” Thematic analysis of our qualitative data revealed a strong consensus across all teams. The triadic partnerships were reported to help reduce the feeling of “distance” in distance learning. Through developing triadic partnerships, our mentorship scheme provided added value beyond that offered previously by staff alone: credible and relatable authenticity within supportive mentoring by alumni. Since the scheme’s launch, student engagement has increased, with high levels of reported satisfaction and positive feedback and greater confidence among all teams. Our research connects the framework developed by Healey et al. (2014, 2016) to the literature on mentoring, offering a conceptual model on triadic partnerships. We encourage readers to consider the different relationships within multidimensional student partnerships in their own contexts.</jats:p

Impact of interactive computerised decision support for hospital antibiotic use (COMPASS): an open-label, cluster-randomised trial in three Swiss hospitals

Background: Computerised decision-support systems (CDSSs) for antibiotic stewardship could help to assist physicians in the appropriate prescribing of antibiotics. However, high-quality evidence for their effect on the quantity and quality of antibiotic use remains scarce. The aim of our study was to assess whether a computerised decision support for antimicrobial stewardship combined with feedback on prescribing indicators can reduce antimicrobial prescriptions for adults admitted to hospital. Methods: The Computerised Antibiotic Stewardship Study (COMPASS) was a multicentre, cluster-randomised, parallel-group, open-label superiority trial that aimed to assess whether a multimodal computerised antibiotic-stewardship intervention is effective in reducing antibiotic use for adults admitted to hospital. After pairwise matching, 24 wards in three Swiss tertiary-care and secondary-care hospitals were randomised (1:1) to the CDSS intervention or to standard antibiotic stewardship measures using an online random sequence generator. The multimodal intervention consisted of a CDSS providing support for choice, duration, and re-evaluation of antimicrobial therapy, and feedback on antimicrobial prescribing quality. The primary outcome was overall systemic antibiotic use measured in days of therapy per admission, using adjusted-hurdle negative-binomial mixed-effects models. The analysis was done by intention to treat and per protocol. The study was registered with ClinicalTrials.gov (identifier NCT03120975). Findings: 24 clusters (16 at Geneva University Hospitals and eight at Ticino Regional Hospitals) were eligible and randomly assigned to control or intervention between Oct 1, 2018, and Dec 31, 2019. Overall, 4578 (40·2%) of 11 384 admissions received antibiotic therapy in the intervention group and 4142 (42·8%) of 9673 in the control group. The unadjusted overall mean days of therapy per admission was slightly lower in the intervention group than in the control group (3·2 days of therapy per admission, SD 6·2, vs 3·5 days of therapy per admission, SD 6·8; p&amp;lt;0·0001), and was similar among patients receiving antibiotics (7·9 days of therapy per admission, SD 7·6, vs 8·1 days of therapy per admission, SD 8·4; p=0·50). After adjusting for confounders, there was no statistically significant difference between groups for the odds of an admission receiving antibiotics (odds ratio [OR] for intervention vs control 1·12, 95% CI 0·94-1·33). For admissions with antibiotic exposure, days of therapy per admission were also similar (incidence rate ratio 0·98, 95% CI 0·90-1·07). Overall, the CDSS was used at least once in 3466 (75·7%) of 4578 admissions with any antibiotic prescription, but from the first day of antibiotic treatment for only 1602 (58·9%) of 2721 admissions in Geneva. For those for whom the CDSS was not used from the first day, mean time to use of CDSS was 8·9 days. Based on the manual review of 1195 randomly selected charts, transition from intravenous to oral therapy was significantly more frequent in the intervention group after adjusting for confounders (154 [76·6%] of 201 vs 187 [87%] of 215, +10·4%; OR 1·9, 95% CI 1·1-3·3). Consultations by infectious disease specialists were less frequent in the intervention group (388 [13·4%] of 2889) versus the control group (405 [16·9%] of 2390; OR 0·84, 95% CI 0·59-1·25). [...]</p