Table 1 Characteristics of included studies

Abimbola et al. 2019 [46]

Qualitative study

Data collection—mixed methods: primary data from ex post interviews, secondary data from existing surveys and interviews

Data analysis—deductive coding using “Nonadoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework” [47]

Australia

CDS tool for treatment of cardiovascular risk: factors influencing uptake and sustained use

Primary care—general practice

Primary data—interview of 5 members of the programme evaluation team (3 chief investigators, 1 project manager, 1 PhD student)

Secondary data—sample size not stated, comprised of a range of participating GPs and health professionals across several previous qualitative studies

Ballard et al. 2017 [48]

Other evaluation

Data collection—surveys

USA

CDS tool for diabetes medications and statins: use of tool and barriers to use amongst providers

Primary care—1 clinic

262 comprised of 42 nurse practitioners, 8 physician assistants, 120 physicians in training, 92 physicians

Chiang et al. 2017 [49]

Other evaluation

Data collection—interviews

Australia

CDS tool for cardiovascular risk evaluation and management: acceptability and feasibility of the tool

Primary care—general practice—1 clinic

5 GPs over 1 day

Cho et al. 2014 [50]

Other evaluation

Data collection—user usage data

USA

CDS tool with medication alerts and drug suggestions for patients with renal insufficiency: appropriateness of overriding alerts

Primary care—general practice—36 clinics

584 prescribers over 3 years

Conway et al. 2018 [51]

Other evaluation

Data collection—surveys, focus groups

UK

CDS tool for diabetes management and prescribing: use of tool, barriers to use and feasibility in practice

Primary care, specialist outpatients—number of clinics not stated

105 health care professionals (GPs/nurses) over 3 months

Dagliati et al. 2018 [52]

Other evaluation

Data collection—surveys, focus groups

Italy

CDS tool for cardiovascular risk calculation: usability and impact on clinical activity

Primary care, specialist outpatients—number of clinics not stated

6 doctors, 1 health care manager

Dixon et al. 2016 [53]

Other evaluation

Data collection—surveys

USA

CDS tool for diabetes and cardiovascular addressing risk factors and medication management: use and perception of tool

Primary care—community health centres—3 clinics

6 healthcare providers after using CDS for 9 months

Fico et al. 2019 [54]

Qualitative study

Data collection—surveys, focus groups

Data analysis—mixed methods evaluation using the “Center for eHealth Research and Disease Management (CeHRes) Roadmap” framework [55]

Italy

CDS tool for diabetes management: user needs, requirements and organisational conditions for successful design and adoption of tool

Specialist outpatients—1 endocrinology clinic

90 healthcare professionals after 2 weeks of CDS use

Gill et al. 2019 [56]

Other evaluation

Data collection—surveys, interviews

USA

CDS tool for diabetes management: facilitators and barriers to implementing tool and achieving optimal management

Primary care—12 clinics

10 staff (physician and clinic staff members) after 1-year follow-up period of CDS

Gold et al. 2019 [57]

Qualitative study

Data collection—interviews (in-person and phone)

Data analysis—inductive approach to thematic analysis, findings presented with “Consolidated Framework for Implementation Research (CFIR)” [58]

USA

CDS tool for ACE inhibitor/ARB and/or statin prescribing (with 3-tiered implementation support): factors influencing effectiveness of tool in improving prescribing practices

Primary care—29 clinics

Number of providers interviewed not stated, interviews from 16 to 33 months of the study

Helldén et al. 2015 [59]

Other evaluation

Data collection—surveys, focus group

Sweden

CDS medication tool for renal drug dosing: ease of use and perceived usefulness of tool

Primary care—general practice—2 clinics

8 GPs using CDS for up to 13 months

Holt et al. 2018 [60]

Qualitative study

Data collection—interviews (in person or by phone)

Data analysis—inductive approach to thematic analysis

UK

CDS for anticoagulation in atrial fibrillation: acceptability and usability of the tool

Primary care—general practice—23 clinics

7 GPs and 15 patients following 6 months use of CDS

Jindal et al. 2018 [61]

Other evaluation

Data collection—interviews

India

CDS tool for hypertension and diabetes management: barriers to implementation and use, and solutions to these challenges

Primary care—community health centres—5 clinics

5 physicians and 5 nurses following 2-month pilot

Kumar et al. 2018 [62]

Qualitative study

Data collection—interviews

Data analysis—inductive approach to thematic analysis

Australia

CDS tool for diabetes management: usability of tool and general views of GPs

Primary care—general practice—4 clinics

6 GPs after using CDS tool for 2 weeks

Litvin et al. 2016 [63]

Other evaluation

Data collection—group interviews

USA

CDS tool for chronic kidney disease screening and management: facilitators and barriers to use

Primary care—12 clinics

25 physicians following 12 months of using CDS

Lopez et al. 2019 [64]

Other evaluation

Data collection—interviews

USA

CDS tool for hypertension management: acceptability and feasibility of intervention

Primary care—13 clinics

Number of providers interviewed not stated—interviewed following 12 months of CDS use

Lugtenberg et al. 2015 [65]

Other evaluation

Data collection—surveys, focus groups

Netherlands

CDS tool for heart failure management: attitudes and perceived barriers

Primary care—general practice—231 clinics

24 primary care practitioners (for focus group), 112 GPs and 52 nurses (for survey) following 12 months of CDS use

Majka et al. 2019 [66]

Other evaluation

Data collection—surveys

USA

CDS tool for cardiovascular risk and statin prescribing in rheumatoid arthritis patients: attitudes and practices towards the tool

Specialist outpatients—1 rheumatology clinic

12 clinicians (including rheumatologists, rheumatology fellows, advanced practice nurses, physician assistants) after CDS use for 14 months

Meador et al. 2018 [67]

Other evaluation

Data collection—surveys, telephone interviews

USA

CDS tool for hypertension diagnosis: perceptions of successes, challenges, and future needs

Primary care—10 clinics

9 project leads following 17 months of CDS tool use

Millery et al. 2011 [68]

Qualitative study

Data collection—interviews

Data analysis—inductive approach to thematic analysis

USA

CDS tool for hypertension detection and management: satisfaction, perceived usefulness of tool and facilitators of change

Primary care—4 clinics

16 providers 3-4 months after using CDS tool, 6 key informants (leadership positions and staff) 5-6 months after CDS tool implemented

O’Reilly et al. 2014 [69]

Other evaluation

Data collection—surveys

Canada

CDS tool for diabetes management: usability and satisfaction

Primary care—family practice—9 clinics

21 participants pre, and 9 participants post 12 months CDS implementation

Orchard et al. 2019 [70]

Qualitative study

Data collection—interviews

Data analysis—mixed methods based on realist evaluation framework [71], inductive approach to thematic analysis

Australia

CDS tool for atrial fibrillation screening: circumstances in which the programme worked or not

Primary care—general practice—16 clinics

21 GPs, 13 nurses, 11 practice managers following approximately 40 months post CDS implementation

Patel et al. 2018 [72]

Qualitative study

Data collection—surveys, interviews

Data analysis—mixed methods with inductive thematic analysis and interpretation based on “normalisation process theory (NPT)” framework [73]

Australia

CDS tool for cardiovascular risk screening and management: impact and factors affecting impact

Primary care—4 general practices and 2 Aboriginal community controlled health services

19 total: 9 GPs, 4 practice managers, 3 Aboriginal health workers, 1 practice nurse, 1 health information office, and 1 administrative assistant/practice manager following 17 months post CDS implementation

Peiris et al. 2011 [74]

Qualitative study

Data collection—interviews (in person or by phone) and survey

Data analysis—inductive approach to thematic analysis

Australia

CDS tool for CVS risk management: attitudes towards tools and impact on consultation

Primary care—general practice—8 clinics

21 GPs following pilot of CDS

Praveen et al. 2014 [75]

Qualitative study

Data collection—interviews, focus group discussions and surveys

Data analysis—inductive approach to thematic analysis

India

CDS tool for cardiovascular risk management: barriers and enablers to use of tool

Primary care—11 villages (field tested) and 3 primary health care centres

11 non-physician health care workers and 3 primary care physicians following 1 month of CDS use

Raghu et al. 2015 [76]

Other evaluation

Data collection—surveys

India

CDS tool for cardiovascular risk: usability of tool

Primary care—field visits in 3 villages

3 GPs and 11 healthcare workers using the CDS tool for 1 month

Regan, 2017 [77]

Other evaluation

Data collection—surveys

USA

CDS tool for chronic kidney disease detection, evaluation, and referral: knowledge and attitudes towards tool

Primary care—11 clinics

55 physicians, 17 nurse practitioners, and 8 physician assistants after using CDS for 3 months

Romero-Brufau et al. 2020 [78]

Other evaluation

Data collection—surveys

USA

CDS for glycaemic control in diabetes: barriers and facilitators of using tool

Primary care—3 clinics

Physicians, registered nurses, licensed practical nurses, social workers (number not specified) after using CDS tool for 3 months

Shemeikka et al. 2015 [79]

Other evaluation

Data collection—surveys, focus groups

Sweden

CDS tool for prescribing in patients with reduced renal function: usefulness and users’ needs

Primary care, specialist outpatients, and inpatient unit—1 geriatric clinic, 1 internal medicine ward, 2 outpatient healthcare centres

38 physicians after CDS use for 5 weeks

Singh et al. 2018 [80]

Qualitative study

Data collection—interviews (in person or by phone)

Data analysis—deductive coding using “Rogers’ diffusion of innovation” theory [81]

India and Pakistan

CDS tool for diabetes: provider perceived benefits, challenges, and value of tool

Specialist outpatients—10 diabetes clinics

39 interviews with physicians (endocrinologists) including 19 pre-implementation, 9 1-year interim, and 11 end-of study interviews at 36 months

Sperl-Hillen et al. 2018 [82]

Other evaluation

Data collection—surveys

USA

CDS too for cardiovascular risk: use, provider satisfaction and perception

Primary care—20 clinics

102 primary care practitioners before and 18 months after using CDS

Vedanthan et al. 2015 [83]

Qualitative study

Data collection—focus group, interviews

Data analysis—mixed methods with both inductive approach to thematic analysis and deductive coding (no theoretical framework stated)

Kenya

CDS tool for hypertension: feasibility, barriers

Primary care—rural clinics (number of clinics not specified)

12 nurses following 1 month use of CDS

Wan et al. 2012 [84]

Qualitative study

Data collection—surveys, phone interviews

Data analysis—inductive approach to thematic analysis

Australia

CDS tool for diabetes management: use, impact, and barriers to use amongst providers

Primary care—general practice (number of clinics not specified)

22 GPs and 2 practice nurses using the CDS for at least 6 weeks