# Qualitative Evaluation of a Clinical Decision-Support Tool for Improving Anticoagulation Control in Non-Valvular Atrial Fibrillation in Primary Care

## TL;DR

Healthcare professionals support a tool to manage anticoagulation in atrial fibrillation patients, but face barriers like alert fatigue and need for better training.

## Contribution

Identifies barriers to adoption of a clinical decision-support system and proposes improvements for better integration and training.

## Key findings

- Healthcare professionals support the clinical decision-support system but face adherence barriers like visualization and alert fatigue.
- Understanding of the time in therapeutic range concept is limited, requiring additional training.
- Participants suggested workflow integration and technical improvements to enhance tool utility.

## Abstract

What are the main findings?
Primary care professionals support a clinical decision-support system for the management of oral anticoagulation in patients with non-valvular atrial fibrillation.Significant barriers to clinical decision-support system adherence were identified, related to its visualization, alert fatigue, understanding of the time in therapeutic range concept, and clinical workload.

Primary care professionals support a clinical decision-support system for the management of oral anticoagulation in patients with non-valvular atrial fibrillation.

Significant barriers to clinical decision-support system adherence were identified, related to its visualization, alert fatigue, understanding of the time in therapeutic range concept, and clinical workload.

What are the implications of the main findings?
To optimize the utility and adoption of the clinical decision-support system, technical improvements in its interface, better integration into the daily clinical workflow, and continuous specific training are required.User perceptions regarding time in therapeutic range and the system indicate the necessity to reinforce theoretical and practical knowledge in oral anticoagulation management for non-valvular atrial fibrillation to ensure informed decision-making.

To optimize the utility and adoption of the clinical decision-support system, technical improvements in its interface, better integration into the daily clinical workflow, and continuous specific training are required.

User perceptions regarding time in therapeutic range and the system indicate the necessity to reinforce theoretical and practical knowledge in oral anticoagulation management for non-valvular atrial fibrillation to ensure informed decision-making.

Objectives: Clinical decision-support systems are computer-based tools to improve healthcare decision-making. However, their effectiveness depends on being positively perceived and well understood by healthcare professionals. Qualitative research is particularly valuable for exploring related behaviors and attitudes. This study aims to explore experiences of family physicians and nurses concerning the visualization, utility and understanding of the non-valvular atrial fibrillation clinical decision-support system (CDS-NVAF) tool in primary care in Catalonia, Spain. Methods: We performed a qualitative study, taking a pragmatic utilitarian approach, comprising focus groups with healthcare professionals from primary care centers in the intervention arm of the CDS-NVAF tool randomized clinical trial. A thematic content analysis was performed. Results: Thirty-three healthcare professionals participated in three focus groups. We identified three key themes: (1) barriers to tool adherence, encompassing problems related to understanding the CDS-NVAF tool, alert fatigue, and workload; (2) using the CDS-NVAF tool: differences in interpretations of Time in Therapeutic Range (TTR) assessments, and the value of TTR for assessing patient risk; (3) participants’ suggestions: improvements in workflow, technical aspects, and training in non-valvular atrial fibrillation management. Conclusions: Healthcare professionals endorsed a clinical decision-support system for managing oral anticoagulation in non-valvular atrial fibrillation patients in primary care. However, they emphasized the view that the CDS-NVAF requires technical changes related to its visualization and better integration in their workflow, as well as continuing training to reinforce their theoretical and practical knowledge for better TTR interpretation.