Scholarlink

Background <p>Chronic kidney disease (CKD) affects approximately one in ten adults globally. Multiple studies have identified underuse of effective therapies in eligible patients with CKD despite guideline endorsement. Clinical decision support (CDS) may increase confidence in prescribing recommended medications, but how end-users perceive it is unknown.</p> Objectives <p>To evaluate clinician-reported perspectives and acceptability of CDS elements for ambulatory CKD management and inform the development of a CKD-specific CDS intervention.</p> Methods <p>Eligible participants for this electronic cross-sectional study were prescribing clinicians from Alberta, Canada, that practiced in ambulatory care settings, including physicians, nurse practitioners, and pharmacists. The survey presented examples of a proposed CDS’ content and format, and collected information on clinician demographics, CKD workflows, perceptions of CDS design, perceived acceptability and clinical utility. Knowledge, comfort, and prescribing patterns were examined for renin-angiotensin system inhibitors (RASi), statins, sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and non-steroidal mineralocorticoid receptor agonists (nsMRA). Participant comfort prescribing each medication class was compared using mean paired differences before and after viewing the proposed CDS.</p> Results <p>Between May and June 2025, 137 clinicians engaged with the survey, 131 completed demographics and 111 completed all survey elements. Most were nephrologists (<i>n</i> = 42; 32%) or general internal medicine specialists (<i>n</i> = 36; 27%). Overall, 88 (79%) supported CDS integration. RASi had the highest self-reported comfort with prescribing followed by statins, SGLT2i, GLP-1RA, and nsMRA. Clinicians reported higher comfort prescribing GLP-1RA and nsMRA with CDS support (median +1 on 9-point scale; <i>p</i> &lt; 0.001), but no change for RASi, statins, and SGLT2i. Participants with low baseline comfort (≤6 on 9-point Likert scale) had statistically significant improvements in comfort with CDS for GLP-1RA and nsMRA (<i>p</i> &lt; 0.05), but no change was observed for those with high baseline comfort.</p> Conclusions <p>Clinicians support CDS integration to enhance CKD care in ambulatory settings. The proposed CDS increased perceived prescribing confidence, particularly for GLP-1RA and nsMRA.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Provider perspectives of clinical decision support for chronic kidney disease management: a cross-sectional study

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2026年7月21日

查看全文
  • Robert Goldberg,
  • Henry Li,
  • Cory E. Goldstein,
  • Kevin Yau,
  • Shannon M Ruzycki,
  • Maoliosa Donald,
  • Meghan J Elliott,
  • Brenda R Hemmelgarn,
  • Matthew T James,
  • Pietro Ravani,
  • Neesh Pannu,
  • Derek Chew,
  • Dilaram Acharya,
  • Tyrone G. Harrison

摘要

Background

Chronic kidney disease (CKD) affects approximately one in ten adults globally. Multiple studies have identified underuse of effective therapies in eligible patients with CKD despite guideline endorsement. Clinical decision support (CDS) may increase confidence in prescribing recommended medications, but how end-users perceive it is unknown.

Objectives

To evaluate clinician-reported perspectives and acceptability of CDS elements for ambulatory CKD management and inform the development of a CKD-specific CDS intervention.

Methods

Eligible participants for this electronic cross-sectional study were prescribing clinicians from Alberta, Canada, that practiced in ambulatory care settings, including physicians, nurse practitioners, and pharmacists. The survey presented examples of a proposed CDS’ content and format, and collected information on clinician demographics, CKD workflows, perceptions of CDS design, perceived acceptability and clinical utility. Knowledge, comfort, and prescribing patterns were examined for renin-angiotensin system inhibitors (RASi), statins, sodium-glucose cotransporter-2 inhibitors (SGLT2i), glucagon-like peptide-1 receptor agonists (GLP-1RA), and non-steroidal mineralocorticoid receptor agonists (nsMRA). Participant comfort prescribing each medication class was compared using mean paired differences before and after viewing the proposed CDS.

Results

Between May and June 2025, 137 clinicians engaged with the survey, 131 completed demographics and 111 completed all survey elements. Most were nephrologists (n = 42; 32%) or general internal medicine specialists (n = 36; 27%). Overall, 88 (79%) supported CDS integration. RASi had the highest self-reported comfort with prescribing followed by statins, SGLT2i, GLP-1RA, and nsMRA. Clinicians reported higher comfort prescribing GLP-1RA and nsMRA with CDS support (median +1 on 9-point scale; p < 0.001), but no change for RASi, statins, and SGLT2i. Participants with low baseline comfort (≤6 on 9-point Likert scale) had statistically significant improvements in comfort with CDS for GLP-1RA and nsMRA (p < 0.05), but no change was observed for those with high baseline comfort.

Conclusions

Clinicians support CDS integration to enhance CKD care in ambulatory settings. The proposed CDS increased perceived prescribing confidence, particularly for GLP-1RA and nsMRA.