Place de la «réactance» des médecins dans la e-iatrogénie: Une étude de cas avec ASTI mode guidé sur la prise en charge de l’hypertension artérielle

Abstract

Clinical decision support systems (CDSSs) have the potential to increase physician’s adherence to clinical practice guidelines (CPGs), but factors of success are not well understood. ASTI-GM is an on-demand guideline-based CDSS where the user interactively describes patient characteristics while browsing the system knowledge base to obtain the recommended treatment. We performed a web-based evaluation of ASTI-GM, carried out as a before-after study, where general practitioners (GPs) were asked to solve 5 clinical cases, first without ASTI-GM, then using the system. During a 2-month period, 266 GPs participated and 1,981 prescription orders were collected. Of the 136 GPs that solved case #2 on the management of hypertension, compliance with best practices increased from 69.1% to 80.9% with ASTI-GM. When the navigation matched the set of patient’s parameters described in the clinical case, the increase was even higher and reached 92.9%. E-iatrogenesis has been measured at 19.1%, with 5.1% of commission errors, 8.1% of negative reactance, and 5.9% of neutral reactance.