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  • Optimising Assessment and Management of Breathlessness with an electronic Clinical Decision Support System
    (2024) Sunjaya, Anthony
    Thesis
    Breathlessness is a highly prevalent, complex symptom in clinical practice, reported in 10-25% of adults in community studies. It is the cardinal symptom of many chronic respiratory and cardiac diseases, and a leading cause of morbidity and mortality. Primary care is uniquely placed to assess and manage patients with breathlessness, especially in countries with Universal Health Coverage like Australia. Even so, the multimorbid and multifactorial causes of chronic breathlessness, ranging from respiratory to cardiac to metabolic diseases, anxiety and deconditioning, create a major diagnostic challenge, with prior studies reporting <30% of referral diagnoses from primary care are concordant with final diagnosis, and that treatment is commenced and continued without objective diagnostic testing such as spirometry for COPD. This thesis across four sections aims to address current gaps in breathlessness care through development of a multifaceted approach, including patient, provider and community perspectives to optimise assessment and management of breathlessness in primary care and to build the case for its implementation and scale up in practice. Section I focuses on understanding the current burden of breathlessness to societies and the current patient journey. In contrast, Section II explores the role of primary care in the assessment and management of breathlessness with a focus on understanding the current implementation gap between clinical guidelines and practice. Through prior studies, expert and data driven approaches, this section provides an example for the development of a chronic breathlessness model of care for primary care. Section III of this thesis focuses on exploring the current landscape of clinical decision support system (CDSS) for breathlessness and its associated conditions. My systematic review found no CDSS that addressed breathlessness as a presenting problem rather than as a symptom of several associated conditions, and the subsequent chapters in the section describe how a CDSS called Breathlessness Rapid Evaluation and THErapy (BREATHE) was developed. Finally, section IV focuses on addressing several of the patient facing gaps with regards to screening, patient education and self-management through online resources and mobile apps via an extensive systematic review and environmental scan of existing resources as well as development of new resources for patient screening and pre-consult support for integration into the BREATHE CDSS.