29 th November 2013

1. “Patient-tailored, guidance-based prescribing – at your fingertips”- computerised decision support 29th November 2013

2. A prescriber’s plea “I read all the relevant papers (some of them twice) and the accompanying editorial, yet came away feeling that I was floundering around in a muddy present rather than striding out into a brave new evidence based future …” • “… I want a simple chart or computer program that will allow me to assess and reduce the risk … I also wish to give patients some idea of the likely benefit they can expect from treatment … So, until someone can clear the waters for me I think I’ll just continue to muddle along.” Aim: to provide patient-tailored, guidance-based prescribing recommendations at the point of care. Ref: Jeffries D. Having so many different guidelines about risk is so confusing. BMJ. 2000; 321:175.

3. Computerised decision support • Demonstrated to improve clinical practice in 64-68% of cases evaluated • Features most associated with improvements in clinical practice: • automatic provision of recommendations as part of the clinician’s workflow • provision of recommendations rather than just assessments • provision of support at the time and location of decision making • use of computer-based support • ‘Provision of assessments or prompts specific to the patient and selected from a knowledge base on the basis of individual patient data’ • potential patient outcomes defined and conceptualised for the ‘individual’ as opposed to ‘average’ patient Refs: Hunt DL et al (1998), Elwyn (2001), Kawamoto et al (2005), Garg et al (2005).

4. Keele’s DSTs cited in ‘Making shared decision-making a reality’ (Kings Fund, 2011)

10. Thank you