A systematic review to assess the components of clinical decision support systems (CDSS) in chronic respiratory disease (CRD) and their relevance to physiotherapy management

Respiratory physiotherapy is key to CRD management. Implementation of guidelines can be limited. CDSS analyse and present data so that users can make decisions more easily. Aim: To review the literature on digital and non-digital CDSS in CRD, summarise their key features and relevance to physiotherapy management. Methods: We systematically reviewed the literature (Aug-Dec 2019) including any study design of digital or non-digital CDSS in adults with CRD. Acute respiratory conditions, systems for diagnosis or exclusively wearables were excluded. Key components were themed. Results: From 1716 studies, 40 studies met the criteria after full text review. The majority were in asthma (n=19) and COPD (n=15) and explored a digital system (33/40; 83%). The function of the systems were general patient management (14/40; 35%), to facilitate shared decision making (7/40; 17.5%); medications management (6/40; 15%); exacerbation management (6/40; 15%); monitoring and treatment (4/40; 10%); to categorise disease severity (2/40; 5%) and adherence monitoring (1/40; 2.5%). Most were based on clinical guidelines (28/40; 70%). Twenty-six (65%) were clinician facing, 12 (30%) patient and clinician facing and 2 (5%) patient facing only. 16/40 (40%) were embedded in an EHR. Conclusions: The majority of CDSS in adults with CRD are digital systems, informed by clinical guidelines, aimed at general patient management. Most systems are clinician facing only and not linked to an electronic healthcare record. Only 2 were linked to physiotherapy management. Acknowledgement: Funded by a Wellcome Institutional Strategic Support Fund, QUB.