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Online appointment scheduling systems have been designed in response to the problems of the traditional ones. In Iran, most outpatient clinics and our study population suffer from high patient' no-show rate and long waiting times because of not using online appointment scheduling system. In this study, the effect of an online appointment scheduling system was investigated by comparing the evaluation metrics of appointment scheduling before and after the intervention. This before-after pilot study was conducted on ten outpatient clinics with different specializations. Five clinics were selected as the intervention group and five clinics as the control group. A checklist was designed to evaluate appointment scheduling metrics. These checklists were completed from April to July 2017 in the pre-implementation phase and from September to December 2017 in the post-implementation phase. The evaluation metrics were evaluated before and after the implementation of the online appointment scheduling system. A total of 470 checklists containing 9034 patients' information and 460 checklists containing 9130 patients' information were completed at the pre- and post-implementation phases, respectively. There were significant positive effect on the improvement of the three metrics means, including Patient waiting time (38.2 min before vs. 23.8 min after the intervention), No-show rate (25% before vs. 11% after the intervention), and Physician punctuality (−30 min before vs. -14.2 min after the intervention). The use of an online appointment scheduling system was successful in improving several evaluation metrics in our target population and resulted in continued usage in intervention group clinics. [ABSTRACT FROM AUTHOR]

To evaluate the effect of a computerized Decision Support System (CDSS) on improving adherence to an anticoagulation guideline for the treatment of atrial fibrillation (AF). This study had an interrupted time series design. The adherence to the guideline was assessed at fortnightly (two weeks) intervals from January 2016 to January 2017, 6 months before and 6 months after intervention. Newly diagnosed patients with AF were included in the offices of ten cardiologists. Stroke and major bleeding risks were calculated by the CDSS which was implemented via a mobile application. Treatment recommendations based on the guideline were shown to cardiologists. The segmented regression model was used to evaluate the effect of CDSS on level and trend of guideline adherence for the treatment of AF. In our analysis, 373 patients were included. The trend of adherence to the anticoagulation guideline for the treatment of AF was stable in the pre-intervention phase. After the CDSS intervention, mean of the adherence to the guideline significantly increased from 48% to 65.5% (P-value < 0.0001). The trend of adherence to the guideline was stable in the post-intervention phase. Our results showed that the CDSS can improve adherence to the anticoagulation guideline for the treatment of AF. Registration ID: IRCT2016052528070N1. [ABSTRACT FROM AUTHOR]

Background: Patients with atrial fibrillation (AF) are at increased risk for stroke. Antithrombotic treatment reduces this risk. Antithrombotic treatment consists of either administration of oral anticoagulants (OAC) or the provision of an antiplatelet drug. International guidelines provide advice on the preferred treatment, thereby balancing the risks and benefits of OAC. However, adherence to these guidelines is reported to be as low as 50%. There is paucity in research on why adherence rates are low. Recent studies have shown decision support systems can improve guideline adherence. We investigate the use of a clinical decision support system to improve guideline adherence among general practitioners (GPs) treating patients with AF and study reasons for guideline non-adherence.Methods/design: The study is a randomized controlled trial, which is performed among Dutch general practitioners. Initially, GPs in the vicinity of the Academic Medical Center (AMC) in Amsterdam will be included, after which other practices will be recruited. We have developed a novel decision support system that displays a list with pending messages for the on-screen medical record in real time. Messages are generated on a server that evaluates a decision rule based on the atrial fibrillation guideline of the Dutch College of General Practitioners. By interacting with the list, messages can be opened for a description and explanation, or be ignored. GPs are allocated into three groups: 1) control group; 2) intervention group A, in which messages can be ignored without justification; and 3) intervention group B, in which messages can only be ignored with justification.Our main outcome measure is the between-group difference in the proportion of patients receiving antithrombotic prescriptions in adherence to the Dutch GP guideline for atrial fibrillation. Secondary outcomes are reasons GPs state for deviating from the guideline and the effect on guideline adherence of requiring justification when ignoring a message.Discussion: This paper describes the protocol for a cluster randomized trial to study the effects of a clinical decision support system in patients with atrial fibrillation. The system is characterized by a non-interruptive presentation and real-time messages that are updated after each relevant action the GP performs.Trial Registration: This trial is registered with the Dutch Trial Register under registration number 3570. [ABSTRACT FROM AUTHOR]