BioMed CentralPage 1 of 11(page number not for citation purposes)BMC Medical Informatics and Decision MakingOpen AccessResearch articleA computer decision aid for medical prevention: a pilot qualitative study of the Personalized Estimate of Risks (EsPeR) systemIsabelle Colombet* 1 , Thierry Dart 1 , Laurence Leneveut 1 , Sylvain Zunino 1 , Joël Ménard 1 , Gilles Chatellier 1 and for the EsPeR Group 1,2,3Address: 1 SPIM, Broussais Hotel Dieu University, ERM 202, INSERM, Paris, France, 2 LERTIM, Faculté de Médecine Université de la Méditerranée, Marseille, France and 3 SC8-INSERM, Le Vésinet, FranceEmail: Isabelle Colombet* - isabelle.colombet@spim.jussieu.fr; Thierry Dart - thierry.dart@spim.jussieu.fr; Laurence Leneveut - laurence.leneveut@wanadoo.fr; Sylvain Zunino - sylvain.zunino@spim.jussieu.fr; Joël Ménard - joel.menard@spim.jussieu.fr; Gilles Chatellier - gilles.chatellier@spim.jussieu.fr; for the EsPeR Group -* Corresponding author AbstractBackground: Many preventable diseases such as ischemic heart diseases and breast cancer prevailat a large scale in the general population. Computerized decision support systems are one of thesolutions for improving the quality of prevention strategies.Methods: The system called EsPeR (Personalised Estimate of Risks) combines calculation of severalrisks with computerisation of guidelines (cardiovascular prevention, screening for breast cancer,colorectal cancer, uterine cervix cancer, and prostate cancer, diagnosis of depression and suiciderisk). We present a qualitative evaluation of its ergonomics, as well as it's understanding andacceptance by a group of general practitioners. We organised four focus groups each including 6–11 general practitioners. Physicians worked on several structured clinical scenari os with the helpof EsPeR, and three senior investigators leaded structured discussion sessions.Results: The initial sessions identified several ergonomic flaws of the system that were easilycorrected. Both clinical scenarios and discussion sessions identified several problems related to theinsufficient comprehension (expression of risks, definition of familial history of disease), anddifficulty for the physicians to accept some of the recommendations.Conclusion: Educational, socio-professional and organisational components (i.e. time constraintsfor training and use of the EsPeR system during consultation) as well as acceptance of evidence-based decision-making should be taken into account before launching computerised decisionsupport systems, or their application in randomised trials.BackgroundIn France, a considerable number of deaths are due to pre-ventable diseases. Ischemic heart diseases and cerebrovas-cular diseases still account for more than 80,000premature deaths and breast cancer, more than 10,000deaths. The control of the main cardiovascular risk factors,such as hypertension, remains poor, both because of lackof awareness and insufficient blood pressure control [1].Published: 27 November 2003BMC Medical Informatics and Decision Making 2003, 3:13Received: 02 July 2003Accepted: 27 November 2003This article is available from: http://www.biomedcentral.com/1472-6947/3/13© 2003 Colombet et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
