Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00035037.xml
Download PDF
Methods Inf Med 2002; 41(02): 98-104
DOI: 10.1055/s-0038-1634292
DOI: 10.1055/s-0038-1634292
Original Article
Design and Implementation of a Computer Decision Support System for the Diagnosis and Management of Dementia Syndromes in Primary Care
Further Information
Publication History
Received:
13 July 2001
Accepted:
18 December 2001
Publication Date:
07 February 2018 (online)
Summary
Background: Diagnosis and management of dementia is a complex process and primary care physicians are under-equipped to deal with uncertainties in the provision of optimal care for the patient.
Objective: To develop a computer decision support system (CDSS) which could assist physicians with diagnosis and management and improve patient care. Methods: A design group including general practitioners derived logic pathways for diagnosis and management of dementia and validated them with a multi-professional expert group. Logic pathways were used to construct a comprehensive CDSS rendered as a series of expert consultations. The CDSS was inserted into commercially available GP systems and bench and field-tested.
Results: The complexity of dementia diagnosis and management can be captured in logic pathways which can be expressed as decision trees within existing electronic patient records. The resulting CDSS appears useable in routine practice.
Conclusion: The impact of this CDSS will be evaluated in a randomised controlled trial of educational interventions in primary care.
-
References
- 1 Gallo J, Franch M, Reichel W. Dementing illness: the patient, caregiver and community. Am Fam Physician 1991; 43 (Suppl. 05) 1669-75.
- 2 Hofman A, Rocca W, Brayne C, Breteler M, Clarke M, Cooper B. et al. The prevalence of dementia in Europe: A collaborative study of 1980-1990 findings. Int J Epidemiol 1991; 20: 736-48.
- 3 Broe GA. et al. Neurological disorders in the elderly at home. J Neurol Neurosurg Psychiatr 1976; 39: 362-6.
- 4 Gray A, Fenn P. Alzheimer’s disease: the burden of the illness in England. Health Trends 1993; 25: 31-7.
- 5 Wimo A, Ljunggren G, Winblad B. Costs of dementia and dementia care: a review. Int J Geriatr Psychiatry 1997; 12: 841-56.
- 6 Moritz D, Petitti D. Association of education with reported age of onset and severity of Alzheimer’s disease at presentation. Am J Epidem 1993; 137 (Suppl. 04) 456-62.
- 7 Levin E, Sinclair I, Gorbach P. Families, Confusion and Old Age. Gower, Aldershot: 1989
- 8 O’Connor D, Pollitt P, Hyde J, Reiss B, Roth M. Do general practitioners miss dementia in elderly patients?. BMJ 1988; 297: 1107-10.
- 9 Iliffe S, Haines A, Gallivan S. et al. Screening for cognitive impairment using the mini-Mental State Examination. Br J Gen Practice 1990; 40: 277-9.
- 10 Rubin SM, Glasser ML, Werckle MA. The examination of physicians’ awareness of dementing disorders. J Am Geriat Soc 1987; 35: 1051-8.
- 11 Ineichen B. Managing demented old people in the community: a review. Fam Pract 1994; 11 (Suppl. 02) 210-5.
- 12 Brodaty H, Howarth GC, Mant A, Kurrle SE. General practice and dementia: a national survey of Australian GP’s. Med J Austral 1994; 160: 10-14.
- 13 Wolff LE. Do general practitioners and old age psychiatrists differ in their attitudes to dementia?. Int J Ger Psych 1994; 10: 63-9.
- 14 Glosser G, Wexler D, Balmelli M. Physicians and families perspectives on the medical management of dementia. J AM Geriatr Soc 1985; 33: 383-91.
- 15 De Lepelaire JA, Heyrman J, Baro F, Buntinx F, Lasuy C. How do general practitioners diagnose dementia?. Fam Pract 1994; 11: 148-52.
- 16 Morgan D, Zhao P. The doctor-caregiver relationship: managing the care of family members with Alzheimer’s Disease. Qual Health Res 1993; 3-2: 133-64.
- 17 Haley W, Clair J, Saulsberry K. Family caregiver satisfaction with the medical care of their demented relatives. Gerontologist 1992; 32: 219-26.
- 18 Chenoweth B, Spencer B. Dementia: the experience of family caregivers. Gerontologist 1986; 26: 267-72.
- 19 Wright J, Ball C, Colemand P. Collaboration in care. Age Concern England; Mitcham: 1988
- 20 Ineichen B. Senile dementia: policy and services Croom Helm. London: 1989
- 21 Fortinsky R. How linked are physicians to community support services for their patients with dementia?. J Applied Gerontology. 1998: 480-98.
- 22 De Lepeleire J, Heyrman J. Diagnosis and management of dementia in primary care at an early stage: the need for a new concept and an adapted structure. Theor Med Bioeth 1999; 20: 215-28.
- 23 Payne TH. Computer decision support systems. Chest 2000; 118 (Suppl. 02) 47S-52S.
- 24 Delaney B, Fitzmaurice DA, Riaz A, Hobbs FDR. Can computerised decision support systems deliver improved quality in primary care?. BMJ 1999; 319: 1281.
- 25 van Wijk M, Mosseveld M, van der Lei J. Design of a decision support system for test ordering in general practice. Choices and decisions to make Methods Inf Med 1999; 38 4-5 355-61.
- 26 Ekdahl C, Karlsson D, Wigertz O, Forsum U. A study of the use of decision support for infective endocarditis. Medical Informatics and the Internet in Medicine 2000; 25 (Suppl. 01) 1-18.
- 27 Glasgow E, McKay HG, Boles SM, Vogt TM. Interactive computer technology, behavioural science and family practice. J Fam Pract 1999; 48 (Suppl. 06) 464-70.
- 28 Montgomery AA, Fahey T, Peters TJ, MacIntosh C, Sharp DJ. Evaluation of computer based clinical decision support system and risk chart for management of hypertension in primary care: randomised controlled trial. BMJ 2000; 320 7236 686-90.
- 29 Linnarson R. Decision support for drug prescription integrated with computer-based patient records in primary care. Med Inf 1993; 18 (Suppl. 02) 131-42.
- 30 Musen MA. Scalable software architectures for decision support. Methods Inf Med 1999; 38 4-5 229-38.
- 31 Ebel MH, Gaspar DL, Khurana S. Family physicians’ preferences for computerised decision support hardware and software. J Fam Pract 1997; 45 (Suppl. 02) 137-41.
- 32 Owens DK. Use of medical informatics to implement and develop clinical practice guidelines. West J Med 1998; 168 (Suppl. 03) 166-75.
- 33 Heathfield HA, Wyatt J. Philosophies for the design and development of clinical decision support systems. Methods Inf Med 1993; 32 (Suppl. 01) 1-8.
- 34 Heathfield H, Pitty D, Hanka R. Evaluating information technology in health care: barriers and challenges. BMJ 1998; 316: 1959-61.
- 35 Eccles M, Clarke J, Livingstone M, Freemantle N, Mason J. North of England evidence based guidelines development project: guideline for the primary care management of dementia. For the North of England Evidence Based Dementia Guideline Development Group. BMJ 1998; 317: 802-8.
- 36 Dimity Pond C, Mant A, Kehoe L, Hewitt H, Brodaty H. General Practitioner diagnosis of depression and dementia in the elderly: Can academic detailing make a difference?. Fam Pract 1994; 11: 141-7.
- 37 Iliffe S, Eden A, Downs M, Rae C. The diagnosis and management of dementia in primary care: development of a national training programme. Ageing & Mental Health 1999; 3: 129-35.
- 38 Rigby M. Health informatics as a tool to improve quality in non-acute care – new opportunities and a matching need for a new evaluation paradigm. Med Inf 1999; 56: 141-50.
- 39 Wyatt J, Spiegelhalter D. Evaluating medical expert systems: what to test and how?. Med Inf 1990; 15: 205-17.
- 40 Johnston ME. et al. Effects of computer based clinical support systems on clinician performance and patient outcome. A critical appraisal of research. Ann Int Med 1994; 120: 135-42.
- 41 Donaldson LJ. From black bag to black box: will computers improve the NHS?. BMJ 1996; 312: 1371-2.