Computer support for determining drug dose: systematic review and meta-analysis

Abstract

Objective To review the effectiveness of computer support for determining optimum drug dose. Design Systematic review of comparative studies where computers gave advice to clinicians on the most appropriate drug dose. Search methods used were standard for the Cochrane Collaboration on Effective Professional Practice. Subjects Comparative studies conducted worldwide and published between 1966 and 1996. Main outcome measures For qualitative review, relative percentage differences were calculated to compare effects of computer support in different settings. For quantitative data, effect sizes were calculated and combined in meta-analyses. Results Eighteen studies met the inclusion criteria. The drugs studied were theophylline, warfarin, heparin, aminoglycosides, nitroprusside, lignocaine, oxytocin, fentanyl, and midazolam. The computer programs used individualised pharmacokinetic models to calculate the most appropriate dose. Meta-analysis of data from 671 patients showed higher blood concentrations of drug with computer support (effect size 0.69, 95% confidence interval 0.36 to 1.02) and reduced time to achieve therapeutic control (0.44, 0.17 to 0.71). The total dose of drug used was unchanged, and there were fewer unwanted effects of treatment. Five of six studies measuring outcomes of care showed benefit from computer assistance. Conclusions This review suggests that using computers to determine the correct dose of certain drugs in acute hospital settings is beneficial. Computers may give doctors the confidence to use higher doses when necessary, adjusting the drug dose more accurately to individual patients. Further research is necessary to evaluate the benefits in general use.

Antibiotic use: How to improve it?

“…However, the organisation of care also offers opportunities to improve antibiotic use. Computerised monitoring systems (Cars et al, 2001;Walton et al, 1999), improved use of pharmacists (Soumerai et al, 1989;Pippalla et al, 1995;Beney et al, 2000;Kaushal et al, 2003), and the deferment of antibiotic use (Arroll et al, 2003) seem likely to be able to contribute to more appropriate antibiotic use.…”

Are we measuring the right end-points? Variables that affect the impact of computerised decision support on patient outcomes: A systematic review

“…Critiquing EDSS have worked better, providing reminders for preventive care or assisting with drug prescribing. The usefulness of EDSS has likely arisen from their ability to use clinical information to answer straightforward questions, such as whether a certain drug was contraindicated or what was an appropriate dose for the medication [6,12]. Implementation of EDSS in these areas should be a high priority [23].…”

Empowering patients or general practitioners? A randomised clinical trial to improve quality in reproductive health care in Belgium

“…A CDSS is defined as any software designed to directly aid clinical decision making, whereby individual patient records are matched with a computer database of guidelines 18 . Results from several systematic reviews suggest that a CDSS is more effective for prevention, drug dosage, and management decisions than for diagnosis 16,19 . The Belgian government provides financial support to GPs who use an approved software programme during patient consultations.…”