{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,27]],"date-time":"2026-06-27T03:10:31Z","timestamp":1782529831289,"version":"3.54.5"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T00:00:00Z","timestamp":1617580800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med Inform Decis Mak"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Despite growing evidence that deprescribing can improve clinical outcomes, quality of life and reduce the likelihood of adverse drug events, the practice is not widespread, particularly in hospital settings. Clinical risk assessment tools, like the Drug Burden Index (DBI), can help prioritise patients for medication review and prioritise medications to deprescribe, but are not integrated within routine care. The aim of this study was to conduct formative usability testing of a computerised decision support (CDS) tool, based on DBI, to identify modifications required to the tool prior to trialling in practice.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Our CDS tool comprised a DBI MPage in the electronic medical record (clinical workspace) that facilitated review of a patient\u2019s DBI and medication list, access to deprescribing resources, and the ability to deprescribe. Two rounds of scenario-based formative usability testing with think-aloud protocol were used. Seventeen end-users participated in the testing, including junior and senior doctors, and pharmacists.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Participants expressed positive views about the DBI CDS tool but testing revealed a number of clear areas for improvement. These primarily related to terminology used (i.e. what is a DBI and how is it calculated?), and consistency of functionality and display. A key finding was that users wanted the CDS tool to look and function in a similar way to other decision support tools in the electronic medical record. Modifications were made to the CDS tool in response to user feedback.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Usability testing proved extremely useful for identifying components of our CDS tool that were confusing, difficult to locate or to understand. We recommend usability testing be adopted prior to implementation of any digital health intervention. We hope our revised CDS tool equips clinicians with the knowledge and confidence to consider discontinuation of inappropriate medications in routine care of hospitalised patients. In the next phase of our project, we plan to pilot test the tool in practice to evaluate its uptake and effectiveness in supporting deprescribing in routine hospital care.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12911-021-01484-z","type":"journal-article","created":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T20:02:36Z","timestamp":1617652956000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Supporting deprescribing in hospitalised patients: formative usability testing of a computerised decision support tool"],"prefix":"10.1186","volume":"21","author":[{"given":"Melissa T.","family":"Baysari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mai H.","family":"Duong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Hooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michaela","family":"Stockey-Bridge","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Selvana","family":"Awad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu Yi","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah N.","family":"Hilmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,4,5]]},"reference":[{"issue":"5","key":"1484_CR1","doi-asserted-by":"publisher","first-page":"827","DOI":"10.1001\/jamainternmed.2015.0324","volume":"175","author":"IA Scott","year":"2015","unstructured":"Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827\u201334.","journal-title":"JAMA Intern Med"},{"issue":"6","key":"1484_CR2","doi-asserted-by":"publisher","first-page":"1254","DOI":"10.1111\/bcp.12732","volume":"80","author":"E Reeve","year":"2015","unstructured":"Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of \u2018deprescribing\u2019 with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80(6):1254\u201368.","journal-title":"Br J Clin Pharmacol"},{"key":"1484_CR3","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.ejim.2016.12.021","volume":"38","author":"E Reeve","year":"2017","unstructured":"Reeve E, Thompson W, Farrell B. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. Eur J Intern Med. 2017;38:3\u201311.","journal-title":"Eur J Intern Med"},{"issue":"3","key":"1484_CR4","doi-asserted-by":"publisher","first-page":"583","DOI":"10.1111\/bcp.12975","volume":"82","author":"AT Page","year":"2016","unstructured":"Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82(3):583\u2013623.","journal-title":"Br J Clin Pharmacol"},{"key":"1484_CR5","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1093\/ageing\/afz133","volume":"49","author":"S Scott","year":"2019","unstructured":"Scott S, Twigg MJ, Clark A, Farrow C, May H, Patel M, et al. Development of a hospital deprescribing implementation framework: a focus group study with geriatricians and pharmacists. Age Ageing. 2019;49:102\u201310.","journal-title":"Age Ageing"},{"issue":"9","key":"1484_CR6","doi-asserted-by":"publisher","first-page":"e030950","DOI":"10.1136\/bmjopen-2019-030950","volume":"9","author":"MT Baysari","year":"2019","unstructured":"Baysari MT, Duong M, Zheng WY, Nguyen A, Lo S, Ng B, et al. Delivering the right information to the right person at the right time to facilitate deprescribing in hospital: a mixed methods multisite study to inform decision support design in Australia. BMJ Open. 2019;9(9):e030950.","journal-title":"BMJ Open"},{"issue":"8","key":"1484_CR7","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1001\/archinte.167.8.781","volume":"167","author":"SN Hilmer","year":"2007","unstructured":"Hilmer SN, Mager DE, Simonsick EM, Cao Y, Ling SM, Windham BG, et al. A drug burden index to define the functional burden of medications in older people. Arch Intern Med. 2007;167(8):781\u20137.","journal-title":"Arch Intern Med"},{"key":"1484_CR8","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.2147\/CIA.S66660","volume":"9","author":"L Kouladjian","year":"2014","unstructured":"Kouladjian L, Gnjidic D, Chen TF, Mangoni AA, Hilmer SN. Drug Burden Index in older adults: theoretical and practical issues. Clin Interv Aging. 2014;9:1503\u201315.","journal-title":"Clin Interv Aging"},{"issue":"3","key":"1484_CR9","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1007\/s00228-016-2162-6","volume":"73","author":"H Wouters","year":"2017","unstructured":"Wouters H, van der Meer H, Taxis K. Quantification of anticholinergic and sedative drug load with the Drug Burden Index: a review of outcomes and methodological quality of studies. Eur J Clin Pharmacol. 2017;73(3):257\u201366.","journal-title":"Eur J Clin Pharmacol"},{"key":"1484_CR10","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/glaa060","author":"J Mach","year":"2020","unstructured":"Mach J, Gemikonakli G, Logan C, Vander Wyk B, Allore H, Ekambareshwar S, et al. Chronic polypharmacy with increasing Drug Burden Index (DBI) exacerbates frailty and impairs physical function, with effects attenuated by deprescribing, in aged mice. J Gerontol A Biol Sci Med Sci. 2020. https:\/\/doi.org\/10.1093\/gerona\/glaa060.","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"1","key":"1484_CR11","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1007\/s11096-019-00784-9","volume":"41","author":"N Ailabouni","year":"2019","unstructured":"Ailabouni N, Mangin D, Nishtala PS. DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities. Int J Clin Pharm. 2019;41(1):167\u201378.","journal-title":"Int J Clin Pharm"},{"issue":"7","key":"1484_CR12","doi-asserted-by":"publisher","first-page":"e019042","DOI":"10.1136\/bmjopen-2017-019042","volume":"8","author":"HG van der Meer","year":"2018","unstructured":"van der Meer HG, Wouters H, Pont LG, Taxis K. Reducing the anticholinergic and sedative load in older patients on polypharmacy by pharmacist-led medication review: a randomised controlled trial. BMJ Open. 2018;8(7):e019042.","journal-title":"BMJ Open"},{"key":"1484_CR13","doi-asserted-by":"crossref","first-page":"204209861983247","DOI":"10.1177\/2042098619832471","volume":"10","author":"L Kouladjian O'Donnell","year":"2019","unstructured":"Kouladjian O\u2019Donnell L, Gnjidic D, Chen TF, Hilmer SN. Integration of an electronic Drug Burden Index risk assessment tool into home medicines reviews: deprescribing anticholinergic and sedative medications. Ther Adv Drug Saf. 2019;10:2042098619832471.","journal-title":"Ther Adv Drug Saf"},{"issue":"1","key":"1484_CR14","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1186\/s12877-020-1442-2","volume":"20","author":"L Kouladjian O'Donnell","year":"2020","unstructured":"Kouladjian O\u2019Donnell L, Sawan M, Reeve E, Gnjidic D, Chen TF, Kelly PJ, et al. Implementation of the goal-directed medication review electronic decision support system (G-MEDSS)\u00a9 into home medicines review: a protocol for a cluster-randomised clinical trial in older adults. BMC Geriatr. 2020;20(1):51.","journal-title":"BMC Geriatr"},{"issue":"2","key":"1484_CR15","doi-asserted-by":"publisher","first-page":"e035656","DOI":"10.1136\/bmjopen-2019-035656","volume":"10","author":"ME Dearing","year":"2020","unstructured":"Dearing ME, Bowles S, Isenor J, Kits O, Kouladjian O\u2019Donnell L, Neville H, et al. Pharmacist-led intervention to improve medication use in older inpatients using the Drug Burden Index: a study protocol for a before\/after intervention with a retrospective control group and multiple case analysis. BMJ Open. 2020;10(2):e035656.","journal-title":"BMJ Open"},{"issue":"8","key":"1484_CR16","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1177\/1060028016652997","volume":"50","author":"L Kouladjian","year":"2016","unstructured":"Kouladjian L, Gnjidic D, Reeve E, Chen TF, Hilmer SN. Health care practitioners\u2019 perspectives on deprescribing anticholinergic and sedative medications in older adults. Ann Pharmacother. 2016;50(8):625\u201336.","journal-title":"Ann Pharmacother"},{"issue":"9","key":"1484_CR17","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1177\/2042098618784809","volume":"9","author":"IA Scott","year":"2018","unstructured":"Scott IA, Pillans PI, Barras M, Morris C. Using EMR-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. Ther Adv Drug Saf. 2018;9(9):559\u201373.","journal-title":"Ther Adv Drug Saf"},{"issue":"5","key":"1484_CR18","doi-asserted-by":"publisher","first-page":"670","DOI":"10.1093\/ageing\/afy086","volume":"47","author":"K Dalton","year":"2018","unstructured":"Dalton K, O\u2019Brien G, O\u2019Mahony D, Byrne S. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis. Age Ageing. 2018;47(5):670\u20138.","journal-title":"Age Ageing"},{"issue":"2","key":"1484_CR19","first-page":"187","volume":"87","author":"EV Murphy","year":"2014","unstructured":"Murphy EV. Clinical decision support: effectiveness in improving quality processes and clinical outcomes and factors that may influence success. Yale J Biol Med. 2014;87(2):187\u201397.","journal-title":"Yale J Biol Med"},{"issue":"8","key":"1484_CR20","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1016\/j.ijmedinf.2014.05.003","volume":"83","author":"KM Vermeulen","year":"2014","unstructured":"Vermeulen KM, van Doormaal JE, Zaal RJ, Mol PG, Lenderink AW, Haaijer-Ruskamp FM, et al. Cost-effectiveness of an electronic medication ordering system (CPOE\/CDSS) in hospitalized patients. Int J Med Inform. 2014;83(8):572\u201380.","journal-title":"Int J Med Inform"},{"issue":"1","key":"1484_CR21","doi-asserted-by":"publisher","first-page":"871","DOI":"10.1186\/s12913-020-05688-3","volume":"20","author":"D Lewkowicz","year":"2020","unstructured":"Lewkowicz D, Wohlbrandt A, Boettinger E. Economic impact of clinical decision support interventions based on electronic health records. BMC Health Serv Res. 2020;20(1):871.","journal-title":"BMC Health Serv Res"},{"issue":"4","key":"1484_CR22","doi-asserted-by":"publisher","first-page":"605","DOI":"10.1093\/ageing\/afaa072","volume":"49","author":"D O'Mahony","year":"2020","unstructured":"O\u2019Mahony D, Gudmundsson A, Soiza RL, Petrovic M, Jose Cruz-Jentoft A, Cherubini A, et al. Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Age Ageing. 2020;49(4):605\u201314.","journal-title":"Age Ageing"},{"issue":"8","key":"1484_CR23","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1111\/jgs.14312","volume":"64","author":"MN O'Connor","year":"2016","unstructured":"O\u2019Connor MN, O\u2019Sullivan D, Gallagher PF, Eustace J, Byrne S, O\u2019Mahony D. Prevention of hospital-acquired adverse drug reactions in older people using screening tool of older persons\u2019 prescriptions and screening tool to alert to right treatment criteria: a cluster randomized controlled trial. J Am Geriatr Soc. 2016;64(8):1558\u201366.","journal-title":"J Am Geriatr Soc"},{"key":"1484_CR24","doi-asserted-by":"publisher","first-page":"l4833","DOI":"10.1136\/bmj.l4833","volume":"366","author":"J Dobson","year":"2019","unstructured":"Dobson J. Co-production helps ensure that new technology succeeds. BMJ. 2019;366:l4833.","journal-title":"BMJ"},{"key":"1484_CR25","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1016\/j.ijmedinf.2019.05.001","volume":"128","author":"M Broekhuis","year":"2019","unstructured":"Broekhuis M, van Velsen L, Hermens H. Assessing usability of eHealth technology: a comparison of usability benchmarking instruments. Int J Med Inform. 2019;128:24\u201331.","journal-title":"Int J Med Inform"},{"issue":"1","key":"1484_CR26","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.jbi.2004.01.003","volume":"37","author":"AW Kushniruk","year":"2004","unstructured":"Kushniruk AW, Patel VL. Cognitive and usability engineering methods for the evaluation of clinical information systems. J Biomed Inform. 2004;37(1):56\u201376.","journal-title":"J Biomed Inform"},{"key":"1484_CR27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijmedinf.2017.06.003","volume":"106","author":"S Richardson","year":"2017","unstructured":"Richardson S, Mishuris R, O\u2019Connell A, Feldstein D, Hess R, Smith P, et al. \u201cThink aloud\u201d and \u201cNear live\u201d usability testing of two complex clinical decision support tools. Int J Med Inform. 2017;106:1\u20138.","journal-title":"Int J Med Inform"},{"issue":"1","key":"1484_CR28","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.jbi.2004.11.006","volume":"38","author":"AF Rose","year":"2005","unstructured":"Rose AF, Schnipper JL, Park ER, Poon EG, Li Q, Middleton B. Using qualitative studies to improve the usability of an EMR. J Biomed Inform. 2005;38(1):51\u201360.","journal-title":"J Biomed Inform"},{"issue":"1","key":"1484_CR29","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1016\/j.artmed.2013.04.004","volume":"59","author":"E Kilsdonk","year":"2013","unstructured":"Kilsdonk E, Peute LW, Riezebos RJ, Kremer LC, Jaspers MWM. From an expert-driven paper guideline to a user-centred decision support system: a usability comparison study. Artif Intell Med. 2013;59(1):5\u201313.","journal-title":"Artif Intell Med"},{"key":"1484_CR30","volume-title":"Usability inspection methods","year":"1994","unstructured":"Nielson J, Mack R, editors. Usability inspection methods. New York: Wiley; 1994."},{"key":"1484_CR31","unstructured":"Budiu R. The power law of learning: Consistency vs. innovation in user interfaces 2016. https:\/\/www.nngroup.com\/articles\/power-law-learning\/."},{"key":"1484_CR32","unstructured":"Nielsen J. Do interface standards stifle design creativity? 1999. https:\/\/www.nngroup.com\/articles\/do-interface-standards-stifle-design-creativity\/."}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01484-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12911-021-01484-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-021-01484-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,5]],"date-time":"2021-04-05T20:02:55Z","timestamp":1617652975000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-021-01484-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,5]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["1484"],"URL":"https:\/\/doi.org\/10.1186\/s12911-021-01484-z","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,5]]},"assertion":[{"value":"18 November 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 April 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Ethics approval was obtained from Northern Sydney Local Health District Human Research Ethics Committee (LNR\/17\/HAWKE\/138). All participants gave informed written consent to researchers to take part and to be audio-recorded. All methods were carried out in accordance with relevant guidelines and regulations.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"116"}}