Abstract
Objectives
Diagnosing venous thromboembolism (VTE) in primary care is challenging due to non-specific symptoms and competing clinical demands. Although clinical decision support (CDS) tools are often proposed to improve diagnostic accuracy, their adoption remains inconsistent. This study aims to explore primary care providers’ (PCPs’) perspectives on diagnosing VTE and identify factors influencing the design, implementation and potential use of a VTE-specific CDS system in primary care.
Design
Qualitative interview study using directed content analysis.
Setting
Primary and urgent care settings across two academic health systems in urban and rural regions of the USA.
Participants
Eight PCPs, including physicians and physician assistants, were purposively sampled from two health systems. Participants practised in primary or urgent care settings and completed semistructured interviews focused on diagnosing VTE and CDS use.
Results
PCPs described diagnosing VTE as challenging because symptoms are often non-specific and encountered in time-constrained clinical environments. Participants viewed a VTE-specific CDS as potentially valuable, particularly if integrated seamlessly into the electronic health record and capable of supporting risk stratification using existing clinical data. However, clinicians also identified substantial concerns regarding alert fatigue, workflow burden, limited specificity and disruption of clinical autonomy. Medico-legal concerns are constructed as a prominent theme, with participants expressing apprehension that ignoring CDS recommendations could increase liability risk, while following alerts could contribute to unnecessary diagnostic testing and downstream consequences. Participants emphasised that CDS tools should be actionable, context-aware, minimally disruptive and supportive of rather than directive to clinical reasoning.
Conclusions
PCPs viewed diagnostic CDS for VTE as potentially beneficial but also potentially burdensome depending on how it is implemented within clinical workflows. Acceptance of CDS appears to depend not only on technical performance but also on its effects on workflow efficiency, clinician autonomy and perceived legal risk. Future CDS development for diagnostic decision-making in primary care should prioritise usability, workflow integration and minimisation of unintended consequences such as alert fatigue and over-testing.