Exploring differential diagnosis decision support systems for trainee advanced practitioners in primary care

Background: In primary care, advanced practitioners from nursing and allied health professions are increasingly deployed to assess, diagnose and manage patients. Differential diagnosis decision support systems may assist trainee advanced practitioners with developing their diagnostic decision-making skills. Aim: To identify which differential diagnosis decision support systems are available to primary care clinicians; review the literature regarding these systems; and identify their positive and negative aspects from the perspective of trainee advanced practitioners in primary care. Method: Market research and a literature review were conducted to identify and explore available systems. In an earlier, larger study, focus groups had been conducted with GPs, advanced practitioners and members of the public. The findings from the focus groups are reported here from the perspective of trainee advanced practitioners. Findings: Four commercially available systems were identified – DXplain, Isabel, PEPID and VisualDx – and explored in terms of accuracy, speed and time efficiency, user feedback, use in education, and use in primary care. Focus group participants expressed the views that such systems could guide and confirm diagnostic decisions, but also raised concerns about their potential to stifle decision-making and inhibit critical thinking. Conclusion: In principle, trainee advanced practitioners are open to using differential diagnosis decision support systems, not necessarily to provide them with the knowledge they do not possess but rather to support and reassure them as they adapt to their new roles.