Download PDF
CC BY-NC-ND 4.0 · Endosc Int Open 2021; 09(11): E1640-E1648
DOI: 10.1055/a-1544-4773
Original article

Usefulness of a mobile app to improve performance of specialists in responding correctly to CRC screening and surveillance clinical scenarios

Lisandro Pereyra
 1   Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina
,
Leandro Steinberg
 2   Gastroenterology Department, Fundación Favaloro, Buenos Aires, Argentina
,
Juan M. Criniti
 3   Internal Medicine Department, Hospital Alemán, Buenos Aires, Argentina
,
Pablo Luna
 1   Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina
,
Rafael Escobar
 4   Gastroenterology Department, Sanatorio Mendez, Buenos Aires, Argentina
,
Maximiliano Bun
 1   Endoscopy Unit, Hospital Alemán, Buenos Aires, Argentina
,
Martín Yantorno
 5   Gastroenterology Department, General San Martín, La Plata, Argentina
,
Sebastian Esteves
 6   Gastroenterology and Endoscopy Department, Clínica Cmic, Neuquén, Argentina
,
Nicolas Gonzalez
 7   Gastroenterology Department, Hospital Británico Montevideo, Uruguay
,
Pablo Hoffman
 8   Gastroenterology Unit, Gedyt, Buenos Aires, Argentina
,
Mariano Marcolongo
 9   Gastroenterology and Endoscopy Department, Hospital Italiano, Buenos Aires Argentina
,
Gastón Jury
10   Gastroenterology Unit, Centro de Estudios Digestivos, Mar Del Plata, Argentina
,
Javier Topor
11   Gastroenterology Department, Sanatorio Mater Dei, Buenos Aires, Argentina
,
Félix Trelles
12   Gastroenterology Department, Hospital Durand, Buenos Aires, Argentina
,
Cristina Nazar
13   Gastroenterology Department, Hospital Bonorino Udaondo, Buenos Aires, Argentina
,
Vitor N. Arantes
14   Endoscopy Unit, Clinics Hospital, Federal University of Minas Gerais, Brasil
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and study aims The adherence to and knowledge of physicians about colorectal cancer (CRC) screening and surveillance guidelines is still suboptimal, threatening the effectiveness of CRC screening. This study assessed the usefulness of a mobile decision support system (MDSS) to improve physician ability to recommend proper timing of and intervals for CRC screening and surveillance.

Patients and methods This was a binational, single-blinded, randomized clinical trial including gastroenterologists and colorectal surgeons from Argentina and Uruguay. The specialists were invited to respond to a questionnaire with 10 CRC screening and surveillance clinical scenarios, randomized into two groups, with and without access to a dedicated app (CaPtyVa). The main outcome measure was the proportion of physicians correctly solving at least 60 % of the clinical cases according to local guidelines.

Results A total of 213 physicians were included. The proportion of physicians responding correctly at least 60 % of the vignettes was higher in the app group as compared to the control group (90 % versus 56 %) (relative risk [RR] 1.6 95 % confidence interval [CI] 1.34–1.91). The performance was also higher in the app group for both vignette categories: CRC screening (93 % vs 75 % RR 1.24, 95 %CI 1.01–1.40) and surveillance (85 % vs 47 % RR 1.81 95 %CI 1.46–2.22), respectively. Physicians considered the app easy to use and of great utility in daily practice.

Conclusions A MDSS was shown to be a useful tool that improved specialist performance in solving CRC screening and surveillance clinical scenarios. Its implementation in daily practice may facilitate the adherence of physicians to CRC screening and surveillance guidelines.



Publication History

Received: 03 February 2021

Accepted: 08 June 2021

Article published online:
12 November 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Grimshaw J, Thomas R, MacLennan G. et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess 2004; 61-72
    PubMedGoogle Scholar
  • 2 Lugtenberg M, Burgers J, Westert G. Effects of evidence-based clinical practice guidelines on quality of care: a systematic review. Qual Saf Health Care 2009; 18: 385-392
    CrossrefPubMedGoogle Scholar
  • 3 Gagliardi A, Alhabib S. Members of Guidelines International Network Implementation Working Group. Trends in guideline implementation: a scoping systematic review. Implement Sci 2015; 21: 54
    CrossrefPubMedGoogle Scholar
  • 4 Durieux P, Nizard R, Philippe R. et al. A clinical Decision Support System for prevention of venous thromboembolism. JAMA 2000; 7: 2816-2828
    CrossrefPubMedGoogle Scholar
  • 5 Hunt DL, Haynes RB, Hanna SE. et al. Effects of computer-based clinical decision support systems on physician performance and patient outcome: a systematic review. JAMA 1998; 280: 1339-1346
    CrossrefPubMedGoogle Scholar
  • 6 McGlynn EA, Asch SM, Adams J. et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003; 348: 2635-2645
    CrossrefPubMedGoogle Scholar
  • 7 Kohn LT, Corrigan JM, Donalson MS. et al. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999
    Google Scholar
  • 8 Vincent C, Neale G, Woloshynowych M. et al. Adverse events in British hospitals: preliminary retrospective record review. BMJ 2001; 322: 517-519
    CrossrefPubMedGoogle Scholar
  • 9 Hunt DL, Haynes RB, Hanna SE. et al. Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review. JAMA 1998; 280: 1339-1346
    CrossrefPubMedGoogle Scholar
  • 10 Bennett JW, Glasziou PP. Computerised reminders and feedback in medication management: a systematic review of randomised controlled trials. Med J Aust 2003; 178: 217-222
    CrossrefPubMedGoogle Scholar
  • 11 Walton RT, Harvey E, Dovey S. et al. Computerised advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev 2001; 1: CD002894
    PubMedGoogle Scholar
  • 12 Walton R, Dovey S, Harvey E. et al. Computer support for determining drug dose: systematic review and meta-analysis. BMJ 1999; 318: 984-990
    CrossrefPubMedGoogle Scholar
  • 13 Kaushal R, Shojania KG, Bates DW. Effects of computerized physician order entry and clinical decision support systems on medication safety: a systematic review. Arch Intern Med 2003; 163: 1409-1416
    CrossrefPubMedGoogle Scholar
  • 14 Bates DW, Teich JM, Lee J. et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6: 313-321
    CrossrefPubMedGoogle Scholar
  • 15 Shea S, DuMouchel W, Bahamonde L. A meta-analysis of 16 randomized controlled trials to evaluate computer-based clinical reminder systems for preventive care in the ambulatory setting. J Am Med Inform Assoc 1996; 3: 399-409
    CrossrefPubMedGoogle Scholar
  • 16 Bates DW, Teich JM, Lee J. et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc 1999; 6: 313-321
    CrossrefPubMedGoogle Scholar
  • 17 Hulscher ME, Wensing M, van der Weijden T. et al. Interventions to implement prevention in primary care. Cochrane Database Syst Rev 2001; 1: CD000362
    PubMedGoogle Scholar
  • 18 Oxman AD, Thomson MA, Davis DA. et al. No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. CMAJ 1995; 153: 1423-1431
    Google Scholar
  • 19 Bray F, Ferlay J, Soerjomataram I. et al. Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin 2018; 68: 394-424
    CrossrefPubMedGoogle Scholar
  • 20 Doubeni C, Fedewa S, Levin T. et al. Modifiable failures in the colorectal cancer screening process and their association with risk of death. Gastroenterology 2019; 156: 63-67
    CrossrefPubMedGoogle Scholar
  • 21 Patell R, Karwa A, Lopez R. et al. Poor knowledge of colorectal cancer screening and surveillance guidelines in a national cohort of digestive disease specialists. Dig Dis Sci 2019; 64: 391-400
    CrossrefPubMedGoogle Scholar
  • 22 Instituto Nacional del Cáncer. Ministerio de Salud de La Nación. Cáncer colorrectal en la Argentina. Organización, cobertura y calidad de las acciones de prevención y control. Informe final de diciembre de 2011; diagnóstico de situación de la Argentina: 2013.
    PubMedGoogle Scholar
  • 23 Iskandar H, Yan Y, Elwing J. et al. Predictors of poor adherence of US gastroenterologists with colonoscopy screening and surveillance guidelines. Dig Dis Sci 2015; 60: 971-978
    CrossrefPubMedGoogle Scholar
  • 24 Patel N, Tong L, Ahn C. et al. Post-polypectomy guideline adherence: importance of belief in guidelines, not guideline Knowledge or fear of missed cancer. Dig Dis Sci 2015; 60: 2937-2945
    CrossrefPubMedGoogle Scholar
  • 25 Djinbachian R, Dubé AJ, Durand M. et al. Adherence to post-polypectomy surveillance guidelines: a systematic review and meta-analysis. Endoscopy 2019; 51: 673-683
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Kawamoto K, Houlihan CA, Balas D. et al. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005; 330: 765
    CrossrefPubMedGoogle Scholar
  • 27 Mandelblatt JS, Yabroff KR. Effectiveness of interventions designed to increase mammography use: a meta-analysis of provider-targeted strategies. Cancer Epidemiol Biomarkers Prev 1999; 8: 759-767
    PubMedGoogle Scholar
  • 28 Wendt T, Knaup-Gregori P, Winter A. et al. Decision support in medicine: a survey of problems of user acceptance. Stud Health Technol Inform 2000; 77: 852-856
    PubMedGoogle Scholar
  • 29 Sim I, Gorman P, Greenes RA. et al. Clinical decision support systems for the practice of evidence-based medicine. J Am Med Inform Assoc 2001; 8: 527-534
    CrossrefPubMedGoogle Scholar
  • 30 Solberg LI, Brekke ML, Fazio CJ. et al. Lessons from experienced guideline implementers: attend to many factors and use multiple strategies. Jt Comm J Qual Improv 2000; 26: 171-188
    PubMedGoogle Scholar
  • 31 Lane DS, Messina CR, Cavanagh MF. et al. A provider intervention to improve colorectal cancer screening in county health centers. Med Care 2008; 46: S109-S116
    CrossrefPubMedGoogle Scholar
  • 32 Schroy PC, Glick JT, Geller AC. et al. A novel educational strategy to enhance internal medicine residents' familial colorectal cancer knowledge and risk assessment skills. Am J Gastroenterol 2005; 100: 677-684
    CrossrefPubMedGoogle Scholar