ID-5184 Wonca Abstracts supplement A-K 13-10-23 - Flipbook - Page 128
WONCA 2023 Supplement 1: WONCA 2023 abstracts (A–K)
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Clinical decision tools and note templates: One step in
reducing the cognitive burden in primary care
Dr Michelle Cangiano, Dr Alicia Jacobs, Faith Robinson
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Larner College of Medicine at the University of Vermont
Clinical decision support (CDS) systems are known to enhance physician practice performance
through improved EHR usability, clinical guideline compliance, EHR integration and real-time
prescription alerts (Moghadam 2021). While EHRs are directly associated with clinician burnout, which
can inhibit performance and impair patient outcome, CDS tools aim to mitigate these negative effects
(Gardner 2019). CDS systems can help reduce clinical burden if they are relevant, customised and
optimised to the provider and integrate clinician feedback (Jankovic 2020). While CDS offers many
benefits to clinicians, little research has focused on the impact of CDS on preoperative assessment
within primary care; most prior studies have focused on CDS within anaesthesiology or on
preoperative assessment of patients with specific disorders such as diabetes (Bau 2014; Chau 2012).
This study examined whether an Assessment, Plan, Subjective, Objective (APSO)-style note template
embedded with CDS tools can improve competence and confidence in providing preoperative
assessments within primary care. The APSO note template was trialled among a group of primary
care providers at a primary care clinic in Colchester, Vermont. Two group qualitative interviews were
performed, transcribed and inductive coding methods were used to determine overarching patterns
within the data. Providers felt that the APSO preop note provided practical clinical decision support
systems that helped guide and improve clinical decision making. Various features of the note, such as
the ease of use and clinical decision tools, were felt to improve competence in navigating the EHR and
providing preoperative assessments. Despite the high frequency of low-risk preoperative assessments
performed in the clinic, providers felt that the APSO preop note was not excessive, although this is an
area for further exploration. Findings from this study indicate the potential of this and other APSO note
templates to serve as CDS systems for providing preoperative care.
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