Computerized advice on drug dosage to improve prescribing practice

Abstract

This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2013, Issue 11. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review.

Computerized advice on drug dosage to improve prescribing practice

“…This update found similar results to the previous review (Durieux 2008), and, in addition, specific therapeutic areas where the intervention is beneficial (the level of evidence was based upon the 'Summary of findings' tables): 1. For oral anticoagulants, CDSS led more often to an INR within the desired range and reduced the time to achieve stabilization of PT and the incidence rates of thromboembolism, in a statistical significant manner.…”

Computerized advice on drug dosage to improve prescribing practice

“…This update found similar results to the previous review (Durieux 2008), and, in addition, specific therapeutic areas where the intervention is beneficial (the level of evidence was based upon the 'Summary of findings' tables): 1. For oral anticoagulants, CDSS led more often to an INR within the desired range and reduced the time to achieve stabilization of PT and the incidence rates of thromboembolism, in a statistical significant manner.…”

Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews

“…The occurrence of adverse (medication) events (eg, bleeding) was nonsignificantly reduced. 23 Mobile stroke units were significantly less effective compared with a regular stroke unit regarding mortality and other composite outcomes. Compared with a treatment in a general medicine ward, mobile stroke units led to a nonsignificantly lower 6-month mortality and 12-month death/dependency rate.…”

“…16-20 The investigated interventions included consultations of clinical pharmacists, 16 hospital-wide geriatric consultation teams, 17 different kinds of organized stroke unit care, 18 implementation of quality indicators as a reporting/feedback tool 19 and hospital-wide, integrated and facility-overspanning practices (eg, geriatric consultation) to deliver care for older patients. 20 Six reviews investigated the effects of structure-related quality-interventions 21-26 addressing the use of personal digital assistants, 21 clinical decision support systems, 22 computerized advice on drug dosage, 23 geriatric evaluation and management units, 26 and stroke units in mobile 24 and inpatient delivery. 25 Most of the included reviews (26/37; 70%) assessed process-related quality-interventions.…”

“…Detailed information about inclusion criteria (item 1), study selection/data extraction (item 2), literature search (item 3), and scientific quality (item 7) were provided in majority. In all, 10 of 37 reviews (27%) partly 16,23,25,35,36,40,46,48 or fully reported 17,45 on the likelihood of publication bias (item 10). Mixed results were shown regarding the inclusion of gray literature (item 4), complete lists of included/excluded studies (item 5), the discussion regarding the scientific quality (item 8) of included primary studies, and if a meta-analysis was conducted methods for pooling of results (item 9).…”

Improving specialist drug prescribing in primary care using task and error analysis: an observational study

“…17 Systematic reviews of controlled trials of CDSSs in primary care settings have demonstrated positive effects linked to the adherence to clinical guidelines, 18,19 improved prescribing, 20 clinician performance, 21 and drug dosing and therapeutic response. 22 However, limitations include a lack of evidence in improving safety measured by medical errors or adverse events, 19 patient outcomes, 23,24 and in the understanding of the impact of CDSSs on specific aspects of the prescribing process. 25 Poor usability has been cited as a core barrier to CDSS adoption, with system designers encouraged to apply common standards based on human-computer interaction methods and user-centred design.…”

Computerized advice on drug dosage to improve prescribing practice

“…This update found similar results to the previous review (Durieux 2008), and, in addition, specific therapeutic areas where the intervention is beneficial (the level of evidence was based upon the 'Summary of findings' tables): 1. For oral anticoagulants, CDSS led more often to an INR within the desired range and reduced the time to achieve stabilization of PT and the incidence rates of thromboembolism, in a statistical significant manner.…”

Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews

“…The occurrence of adverse (medication) events (eg, bleeding) was nonsignificantly reduced. 23 Mobile stroke units were significantly less effective compared with a regular stroke unit regarding mortality and other composite outcomes. Compared with a treatment in a general medicine ward, mobile stroke units led to a nonsignificantly lower 6-month mortality and 12-month death/dependency rate.…”

“…16-20 The investigated interventions included consultations of clinical pharmacists, 16 hospital-wide geriatric consultation teams, 17 different kinds of organized stroke unit care, 18 implementation of quality indicators as a reporting/feedback tool 19 and hospital-wide, integrated and facility-overspanning practices (eg, geriatric consultation) to deliver care for older patients. 20 Six reviews investigated the effects of structure-related quality-interventions 21-26 addressing the use of personal digital assistants, 21 clinical decision support systems, 22 computerized advice on drug dosage, 23 geriatric evaluation and management units, 26 and stroke units in mobile 24 and inpatient delivery. 25 Most of the included reviews (26/37; 70%) assessed process-related quality-interventions.…”

“…Detailed information about inclusion criteria (item 1), study selection/data extraction (item 2), literature search (item 3), and scientific quality (item 7) were provided in majority. In all, 10 of 37 reviews (27%) partly 16,23,25,35,36,40,46,48 or fully reported 17,45 on the likelihood of publication bias (item 10). Mixed results were shown regarding the inclusion of gray literature (item 4), complete lists of included/excluded studies (item 5), the discussion regarding the scientific quality (item 8) of included primary studies, and if a meta-analysis was conducted methods for pooling of results (item 9).…”

Improving specialist drug prescribing in primary care using task and error analysis: an observational study

“…17 Systematic reviews of controlled trials of CDSSs in primary care settings have demonstrated positive effects linked to the adherence to clinical guidelines, 18,19 improved prescribing, 20 clinician performance, 21 and drug dosing and therapeutic response. 22 However, limitations include a lack of evidence in improving safety measured by medical errors or adverse events, 19 patient outcomes, 23,24 and in the understanding of the impact of CDSSs on specific aspects of the prescribing process. 25 Poor usability has been cited as a core barrier to CDSS adoption, with system designers encouraged to apply common standards based on human-computer interaction methods and user-centred design.…”

Computerized advice on drug dosage to improve prescribing practice

“…This update found similar results to the previous review (Durieux 2008), and, in addition, specific therapeutic areas where the intervention is beneficial (the level of evidence was based upon the 'Summary of findings' tables): 1. For oral anticoagulants, CDSS led more often to an INR within the desired range and reduced the time to achieve stabilization of PT and the incidence rates of thromboembolism, in a statistical significant manner.…”

Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews

“…The occurrence of adverse (medication) events (eg, bleeding) was nonsignificantly reduced. 23 Mobile stroke units were significantly less effective compared with a regular stroke unit regarding mortality and other composite outcomes. Compared with a treatment in a general medicine ward, mobile stroke units led to a nonsignificantly lower 6-month mortality and 12-month death/dependency rate.…”

“…16-20 The investigated interventions included consultations of clinical pharmacists, 16 hospital-wide geriatric consultation teams, 17 different kinds of organized stroke unit care, 18 implementation of quality indicators as a reporting/feedback tool 19 and hospital-wide, integrated and facility-overspanning practices (eg, geriatric consultation) to deliver care for older patients. 20 Six reviews investigated the effects of structure-related quality-interventions 21-26 addressing the use of personal digital assistants, 21 clinical decision support systems, 22 computerized advice on drug dosage, 23 geriatric evaluation and management units, 26 and stroke units in mobile 24 and inpatient delivery. 25 Most of the included reviews (26/37; 70%) assessed process-related quality-interventions.…”

“…Detailed information about inclusion criteria (item 1), study selection/data extraction (item 2), literature search (item 3), and scientific quality (item 7) were provided in majority. In all, 10 of 37 reviews (27%) partly 16,23,25,35,36,40,46,48 or fully reported 17,45 on the likelihood of publication bias (item 10). Mixed results were shown regarding the inclusion of gray literature (item 4), complete lists of included/excluded studies (item 5), the discussion regarding the scientific quality (item 8) of included primary studies, and if a meta-analysis was conducted methods for pooling of results (item 9).…”

Improving specialist drug prescribing in primary care using task and error analysis: an observational study

“…17 Systematic reviews of controlled trials of CDSSs in primary care settings have demonstrated positive effects linked to the adherence to clinical guidelines, 18,19 improved prescribing, 20 clinician performance, 21 and drug dosing and therapeutic response. 22 However, limitations include a lack of evidence in improving safety measured by medical errors or adverse events, 19 patient outcomes, 23,24 and in the understanding of the impact of CDSSs on specific aspects of the prescribing process. 25 Poor usability has been cited as a core barrier to CDSS adoption, with system designers encouraged to apply common standards based on human-computer interaction methods and user-centred design.…”