Determinants of sustainable adoption in primary care of a clinical decision support system for antimicrobial prescribing: A qualitative study

The objective of the study was to analyse the determinants for sustainable adoption by General Practitioners (GPs) of Antibioclic, a Clinical Decision Support System (CDSS) for antimicrobial prescribing, and the results of and limitations to its use in clinical practice.

Individual interviews with GPs and a focus group were carried out concerning their use of Antibioclic, a CDSS for antimicrobial prescribing in primary care. Antibioclic is a publicly funded, freely available CDSS targeting 48 common infectious diseases. Interviews were recorded, transcribed and coded using NVivo 12. Data were analysed via inductive thematic analysis.

Interviews were conducted with 25 GPs, and nine additional GPs participated in the focus group. Median age was 34 years (IQR 32-43) and 20 participants (59 %) were women. All of them frequently and sustainably used Antibioclic in their practice. Adoption of the CDSS was explained by system characteristics: usability, up-to-dating and trustworthiness; it was also considered as routinized, interwoven with consultations and antimicrobial prescribing, and conducive to improved practices and communication with patients. The GPs emphasized the role of CDSSs role in bridging the gap between clinical guidelines and daily practice, while contributing to contextual learning and continuous medical education. Lastly, participants pointed out the importance of co-design of CDSSs with end-users.

These determinants of sustainable adoption of a CDSS may guide future implementation of electronic tools in into clinical practice.