The Personalisation Paradigm: Leveraging Clinical Decision Support Tools to Redefine Non-Communicable Disease (NCD) Care

Therapeutic inertia remains a barrier to achieving optimal glycaemic control among people living with diabetes, particularly in resource-constrained primary care settings. To address this, a Clinical Decision Support System (CDSS) was integrated into a digital health platform to provide treatment intensification recommendations to clinicians during patient encounters. This study evaluated the effectiveness of clinician-implemented treatment intensification following CDSS recommendations on glycaemic outcomes among diabetes patients in Kenya and Ghana. We conducted a retrospective observational study using routinely collected programme data from patients for whom a CDSS treatment recommendation was generated during a medical review. Patients with 3–6-month follow-up glycaemic measurements after the CDSS recommendation were included. The primary outcome was achievement of glycaemic control at follow-up. Multivariable logistic regression was used to evaluate the association between treatment intensification and glycaemic outcomes. Of the 1,415 patients for whom treatment intensification was recommended, 831 (59%) had their treatment intensified. Of these, 1,069 (76%) patients had documented glycaemic follow-up between 3 and 6 months and were included in the analysis. Patients whose treatment was intensified were more likely to achieve glycaemic control than those whose treatment remained unchanged (34% vs. 12%; adjusted odds ratio [aOR] 4.47, 95% confidence interval 3.13–6.39). Treatment intensification was associated with improved glycaemic outcomes in routine primary care. However, CDSS effectiveness depended on translating recommendations into clinical action, indicating that digital decision support alone may be insufficient without processes that enable treatment optimisation. Future CDSS should evolve beyond reminder-based systems to support individualised treatment selection.