Asthma Diagnosis in Primary Care: How do you implement a decision support system in practice? – Luke Daines
In the final instalment of his blog series, Luke Daines reflects on his end of PhD workshop discussing asthma diagnosis in primary care
As well as having discussion groups for patient and professional priorities, a third group focussed on how a system like Asthma Diagnosis Decision Aid (ADxDA) could be implemented in practice.
Clinical decision support systems (CDSS) only work if they are used! Thinking beyond the appearance and technical features of the software, the final group from my end of PhD workshop considered how the ADxDA tool may be most usefully applied. Given the near stop of lung function testing during the Covid-19 pandemic, participants acknowledged that there would be a large backlog of demand for spirometry (and FeNO) in primary care.
Even before this demand, many parts of the UK still did not have clear diagnostic hubs established, so one purpose for the CDSS could be to identify those individuals who are most likely to benefit from testing. Implementing the software should be completed in partnership with secondary care. The opportunity to rethink the pathway for patients presenting with symptoms to suggest asthma was attractive, by integrating primary care, secondary care and respiratory physiology to improve the patient experience. This could be done through a reduction in unnecessary appointments and travel whilst maximising the experience and expertise of different health professionals.
Patient and professional expectations
A theme that arose in this group was how health care professionals could communicate doubt to their patients, particularly when a diagnosis is not straight-forward. A way that ADxDA could help both parties could be the wording produced by the software when aiding the decision-making process. Having a phrase such as ‘85% of your colleagues would say this is asthma’ could reassure both patients and professionals more than ‘low, medium or high’ probability of asthma. It may also ensure the discussion is continued to create a better patient experience when being referred between primary and secondary care.
Next steps
Having a promising prediction model and early designs for a decision support software are more than I hoped to achieve during my PhD, but still represent only the early stages in producing a finished decision support system!
The workshop provided a great opportunity to hear the views of a wide range of stakeholders, which provided valuable feedback and have helped to shape the next stages of the project. Be sure to keep up to date with the next steps of the ADxDA on the project webpage.
Thank you to everyone who took part in my workshop and a special mention to the brilliant team from the Asthma UK Centre for Applied Research who supported me in making the virtual workshop a success!