Influence of the use of a tablet-based clinical decision support algorithm by general practitioners on the consultation process: the example of FeverTravelApp

Abstract

Abstract Background Despite the proven positive effects of clinical decision support systems (CDSSs) on general practitioners’ (GPs’) performance and patient management, their adoption remains slow. Several factors have been proposed to explain GPs' reluctance to adopt these tools. This study hypothesizes that the influence of CDSSs on patient-physician interactions could be a determining factor. To explore this hypothesis, we utilized the FeverTravelApp, designed to assist GPs in managing patients presenting with fever after returning from the tropics. A case–control study was conducted, observing and analyzing fourteen consultations between seven physicians and three simulated patients. Each physician conducted consultations both with and without the FeverTravelApp. The consultations were video-recorded and analyzed using a custom analysis grid based on three existing tools. Simulated patients completed the Communication Assessment Tool (CAT) after each consultation, and each physician participated in a semistructured interview following the use of the app. Results The use of the FeverTravelApp influenced multiple aspects of the consultation, particularly communication. Both patient and GP speaking times decreased, while active silence (no one talking while the GP actively performed a task) increased. GPs focused more on the app, which reduced direct patient interaction. However, this influence seemed to bother GPs more than simulated patients, who rated their GPs equally whether the app was used or not. This could be because patients felt better understood when GPs asked fewer but more specific questions related to travel medicine, thus effectively addressing their concerns. Conclusions This study supports the hypothesis that CDSSs influence consultation dynamics, which may contribute to their slow adoption. It is essential to involve clinicians early in the development of CDSSs to adapt them to clinical workflows and ensure system interoperability. Additionally, tools that allow clinicians to follow the entire clinical reasoning process, such as decision trees, are needed. Further research is necessary to confirm these findings in real patient settings and to develop CDSSs that meet both patients’ and GPs’ expectations.

Keywords

• Clinical Decision Support Systems (CDSSs)
• FeverTravelApp
• General practitioners
• Patient-physician interaction
• Travel medicine
• Communication