Current evidence on the efficacy of clinical decision support system prompts in increasing testing for blood-borne viruses: a narrative review

BACKGROUND: Rates of late diagnosis of blood-borne viruses [BBVs] (HIV, hepatitis C and hepatitis B) remain high despite testing guidelines and other efforts, including the development and implementation of clinical decision support systems [CDSS] in primary care to increase testing among those at risk.

AIM: A narrative review of international literature was conducted to analyse the effectiveness of CDSS prompts in increasing testing and identify barriers and facilitators to implementation. 

METHOD: To identify and collate existing studies utilising CDSS to increase testing for BBVs, a narrative review was performed. There was no predetermined question, only a topic of interest. The review synthesised the findings retrieved from searches of computerised databases, hand searches and authoritative texts to provide an overview of available literature. 

RESULTS: Forty-eight studies from seven countries were included. Evidence of effectiveness was provided with increased testing in 38 studies, of which 16 demonstrated increased rates of new diagnoses. Key barriers to use included lack of knowledge of BBVs and/or risk, propensity to test, time constraints, stigma, alert fatigue, and implicit or subconscious bias. Main facilitators of use were training on BBVs, iterative reflexive implementation approaches, seamless integration into existing systems and the importance of an advocate to promote use. 

CONCLUSION: Current evidence advocates the use of CDSSs utilising a test prompt to enhance screening for BBVs, though consideration is needed in implementation. Further research is needed to explore whether the increased testing associated with CDSSs increases detection of people living with undiagnosed BBVs and leads to improved outcomes.