A study published in the Journal of Medical Internet Research has explored “alert fatigue” from clinical reminders (CRs) amongst GPs, with concerns around design, content accuracy, and “lack of contextual nuance”. Authors suggest ways to overcome this and improve adherence to CRs, including working with GPs on their design, undertaking training on their use and benefits at an organisation level, and sharing best practices on their effective use.
Pointing first to the “growing sophistication of medical knowledge and the electronic systems that manage patient data and inform clinical decision-making”, authors note the effect this has had on the regularity of CRs, and the associated “cognitive load placed on GPs”. Not all CRs are acted upon, the study finds, and whilst in some cases that may be due to their irrelevance or inapplicability, “increasingly GPs are disregarding pertinent or urgent CRs, a chronic negligence commonly referred to as alert fatigue”.
Aiming to improve understandings around GP attitudes to CRs within their role, authors adopted “best practices in systematic review methodology and directed content analysis”, presenting results “through the lens of the NASSS framework developed to support, guide, and monitor the implementation of digital technologies in health and social care”. In doing so, they considered domains, definitions, and influences on implementation, including intended users, acceptability to service users, and the work required in implementation.
A total of nine studies published between 2003 and 2021 were included, with five of those being from the UK, and one each from Australia, Belgium, The Netherlands, and Norway. Data from these studies was then mapped against the NASSS framework, allowing the authors an insight into study outcomes, design, the tested purpose of the CR, participants, and key findings.
Key findings from this process covered domains such as medication, diagnosis, and ongoing management, finding an “overabundance” of CRs, a “preference for accompanying information that aided comprehension” of CRs, that CRs requiring a response “disrupted” the workflow, concerns around accuracy and relevance, and that CRs were “valued for their ability to provoke a decision, particularly in busy environments”.
Four studies noted that inability to process a large number of alerts “was a concern” amongst GPs; whilst three shared that “pop-up CRs that required the checking of drop-down lists or otherwise had to be actioned before any next step were overly disruptive and actually inhibited their engagement with the CRs content”. In five studies, however, GPs reported that CRs were “capable of improving patient safety by promoting reflection on their decision”; whilst one study highlighted GP opinions that CRs could improve long-term practice “by their ability to promote and reinforce appropriate prescribing behaviors”.
When considering factors which influenced GPs engagement with CRs, the studies noted the impact of “hesitation in relying on a computer-generated algorithm”, examples of “unrecognised contraindications” such as drug-drug interactions mentioned in textbooks not being picked up, and the need for “greater transparency between the clinical evidence and the presentation of the CR”.
In particular, training and system capacity yielded significant results to inform suggestions to improve adherence to CRs, with five studies noting the importance of training on the purposes of CRs and their functionality, and GPs sharing how time pressures reduced their ability to properly interact with CRs.
Summing up the key elements of these findings, the study’s authors highlighted that the use of CRs in areas such as diagnosis, prescribing and ongoing management of chronic conditions “was seen as an effective means of maintaining or improving safe and high-quality care, albeit with contrasting effects on clinician self-efficacy”. The efficacy of CRs was found to be “directly linked to their frequency, the presentation and accuracy of their content, and the speed and reliability of IT infrastructure and hardware”; whilst for adopter attitudes, GPs held concerns about accuracy and loss of benefits from their clinical experience and patient context.
From an organisation perspective, authors continued, “the importance of training and the ability of CRs to integrate seamlessly with existing workflows were emphasised”; .whilst suggestions to improve usability for CRs included “the sharing of best practices and involving GPs earlier in the design process to ensure successful embedding over time”.
The study concludes with a series of ten recommendations, including for technology, that a “visual-driven user interface” is used to present information “more effectively” and reduce information overload; for adoption, that “GP-endorsed” or recommended CRs “would promote and increase their uptake”, and that CRs should “transparently reflect the latest clinical evidence”; and for organisation, around greater engagement and training on CRs, as well as better incorporation of CRs into existing workflows. Other recommendations include encouraging GP-stakeholder collaboration enabling feedback and co-design, and enabling alert customisation to allow GPs to deactivate “unnecessary output”.
Citation: Gani I, Litchfield I, Shukla D, Delanerolle G, Cockburn N, Pathmanathan A. Understanding “Alert Fatigue” in Primary Care: Qualitative Systematic Review of General Practitioners Attitudes and Experiences of Clinical Alerts, Prompts, and Reminders. J Med Internet Res 2025;27:e62763. URL: https://www.jmir.org/2025/1/e62763. DOI: 10.2196/62763
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