Using a Clinical Decision Support System to Improve Anticoagulation in Patients with Nonvalve Atrial Fibrillation in China's Primary Care Settings: A Feasibility Study.

Background: To primarily investigate the effect of using a clinical decision support system (CDSS) in community health centers in Shanghai, China, on the proportion of patients prescribed guideline-directed antithrombotic therapy. This study also gauged the general practitioner (GP)'s acceptance of the CDSS who worked in the atrial fibrillation (AF) special consulting room of the CDSS group. Methods: This was a prospective cohort study that included a semistructured interview and a feasibility study for a cluster-randomized controlled trial. Eligible patients who sought medical care in the AF special consulting rooms in two community health centers in Shanghai, China, between April 1, 2020, and October 1, 2020, were enrolled, and their medical records from the enrollment date, up to October 1, 2021, were extracted. Based on whether the GPs in the AF special consulting rooms of the two sites used the CDSS or not, we classified the two sites as a software group and a control group. The CDSS could automatically assess the risks of stroke and bleeding and provide suggestions on treatment, follow-up, adjustment of anticoagulants or dosage, and other items. The primary outcome was the proportion of patients prescribed guideline-directed antithrombotic therapy. We also conducted a semistructured interview with the GP in the AF special consulting rooms of the software group regarding the acceptance of the CDSS and suggestions on the optimization of the CDSS and the study protocol of the cluster-randomized controlled trial in the future. Results: Eighty-four patients completed the follow-up. The mean age of these subjects was 75.71 years, the median time of clinical visits was six times per person, and the follow-up duration was 15 months. The basic demographics were similar between the two groups, except for age (t = 2.109, p = 0.038) and the HAS-BLED score (χ 2 = 4.363, p = 0.037). The primary outcome in the software group was 8.071 times higher than that in the control group (adjusted odds ratio (OR) = 8.071, 95% confidence interval (2.570-25.344), p < 0.001). The frequency of consultation between groups was not significantly different (p = 0.981). It seemed that the incidence of adverse clinical events in the software group was lower than that in the control group. The main reason for dropouts in both groups was "following up in other hospitals." The GP in the AF special consulting rooms of the software group accepted the CDSS well. Conclusions: The findings indicated that it was feasible to further promote the CDSS in the study among community health centers in China. The use of the CDSS might improve the proportion of patients prescribed guideline-directed antithrombotic therapy. The GP in the AF special consulting room of the software group showed a positive attitude toward the CDSS.

Work competence of general practitioners working in the community health services of Shanghai: a cross-sectional study based on self-assessment.

OBJECTIVES: The aim of the study was to investigate the work competence of general practitioners (GPs) in the community health services (CHSs) of Shanghai, China. METHODS: A questionnaire was designed based on a previous capacity evaluation indicator system. We used a stratified and proportional cluster sampling method in this self-assessment and cross-sectional study. We collected data with the questionnaire on GPs' demographic variables and work competence including patient care ability, teaching ability, communication skill and coordination ability. Univariate analyses were performed by Mann-Whitney U test and Kolmogorov-Smirnov test. Multivariate analyses were done with generalized liner model with significant univariate factors. RESULTS: A total of 2954 GPs were sampled from 116 CHSs in Shanghai. The response rate was 99.9%. The median scores of patient care ability, teaching ability, communication skill and coordination ability were 80[70-88.75], 76[60-80] and 80[70-85] on a scale of 100, respectively. GPs who were 30-39 years old, or worked in urban CHSs, or took GP trainer's training or had teaching experience got higher scores in patient care ability. GPs who worked for 5-19 years in CHSs, or worked in CHSs with GP training program or took GP trainer's training had higher scores in teaching ability. For communication skill and coordination ability, GPs who worked in CHSs with GP standardized training program, or took GP trainer's training or had teaching experience in CHSs got higher scores. CONCLUSIONS: The work competence of GPs in CHSs of Shanghai could mainly cover daily work, but still needed more improvement in teaching ability.

Effect of an artificial intelligence-assisted tool on non-valvular atrial fibrillation anticoagulation management in primary care: protocol for a cluster randomized controlled trial.

BACKGROUND: Atrial fibrillation (AF) is one of the most common cardiac arrhythmia diseases. Thromboembolic prophylaxis plays an essential role in AF therapy, but at present, general practitioners (GPs) are presumed to lack the knowledge and enthusiasm for AF management. Clinical decision support systems (CDSS), assisted by artificial intelligence, help primary care providers (PCPs) make quick, individualized, and correct clinical decisions. This primary aim of the study is to identify whether the promotion of the CDSS would improve the primary care provided to patients with AF. The secondary objectives are mainly to assess the health-economic and clinical benefits from using the CDSS, and the improvement of GPs' AF management capability. METHODS: This study will be a prospective cluster randomized controlled trial, conducted among 14 community health centers in Shanghai which were randomized as the intervention group and control group in a ratio of 1:1. The intervention group will use the CDSS in the consultation of patients with AF and the control group will maintain their usual care. The trial will include 498 patients with AF and the follow-up period will be 12 months. The primary outcome is set as the proportion of antithrombotic treatment prescriptions in agreement with recommendations in the latest China's AF-related guidelines. The secondary outcomes are the frequency of consultation, the compliance rate of international normalized ratio (INR) in patients with warfarin, stroke morbidity, treatment compliance, medication satisfaction, and the cost-benefit analysis. Per-protocol (PP) analysis and the intention-to-treat (ITT) analysis will be conducted. DISCUSSION: This study aims to identify whether the application of CDSS to manage patients with AF in China's community health centers would bring benefits for patients, physicians, and health economics. TRIAL REGISTRATION: Registry name: AI (Development and promotion of an AI-assisted tool for NVAF management in primary care); registry number: ChiCTR2100052307; registration date: Nov. 22nd, 2021; http://www.chictr.org.cn/showproj.aspx?proj=133849 .