Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol

Quindroit, Paul; Baclet, Nicolas; Gerard, Erwin; Robert, Laurine; Lemaître, Madleen; Gautier, Sophie; Delannoy-Rousselière, Chloé; Décaudin, Bertrand; Vambergue, A.; Beuscart, Jean-Baptiste

doi:10.3390/healthcare9111539

Cited by 4 publications

(5 citation statements)

References 31 publications

(39 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Not performed or not included in the clinical records could likewise lead to inappropriate prescribing. Validated criteria to assess inappropriate prescriptions in T2DM have not been developed so far [ 29 ]; however, criteria used in this study are quite consistent with those used elsewhere. Since there is no clear information on adherence, prescribing does not mean taking the medication; in addition, several drugs, when associated with lack of control, may be a risk marker more than a risk factor.…”

Section: Discussionmentioning

confidence: 99%

Prescription of oral antidiabetics in Mexico. A cross-sectional study

Fierro,

Gallardo-Mora,

Alba-Leonel

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

In 2016 diabetes was declared an epidemic and a health emergency in Mexico. As the rationale of the treatment is to achieve target glycemia levels, the appropriateness of the medications used is important. The aim of this study is to learn the pattern of antidiabetic drug prescription and factors associated with inappropriate prescription in Mexico. A retrospective cross-sectional drug utilization study has been conducted. A randomly selected sample was carefully examined. Out of 3600 clinical records of patients diagnosed with type 2 diabetes mellitus (T2DM), 196 records were revised. As far as control is concerned, 36.7% had their glycemia values in the recommended range. A combination of different antidiabetics was the most common pattern observed (60.7%); the most frequent was that of the association of metformin with whatever oral antidiabetics. Prescriptions were considered as inappropriate in 149 cases (76.0%); younger age and lack of nutritional assessment was significantly related to inappropriate prescription. A trend to use more drugs for treating T2DM has been consistently observed. Despite using so many drugs, most of the patients are not controlled. Avoiding inappropriate prescription by following current guidelines may contribute to a better control and, in turn, decrease morbidity and mortality for this cause.

show abstract

Section: Discussionmentioning

confidence: 99%

Prescription of oral antidiabetics in Mexico. A cross-sectional study

Fierro,

Gallardo-Mora,

Alba-Leonel

et al. 2023

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…Future challenges will concern the collective use of CDSS by several healthcare professionals such as nurses, general practitioners and clinical pharmacists to promote larger multidisciplinary approaches thanks to CDSS. The present work is part of a larger, multidisciplinary research project on inappropriate prescriptions in patients with diabetes; one of the next steps will be the development of antidiabetic drug rules for inclusion in the CDSS, and its implementation in primary care 41 …”

Section: Discussionmentioning

confidence: 99%

“…Constant re-assessment of the rules is also important for ensuring specificity and avoiding spurious alerts and alert fatigue 15,40. These rules can evolve through multidisciplinary collaboration work based on systematic reviews, qualitative studies and validation by consensus 41. This approach might help to extend the CDSS's field of competence to: (i) drugs not currently detected; (ii) more specific patient profiles; and (iii) different contexts.…”

mentioning

confidence: 99%

Implementation of a clinical decision support system for the optimization of antidiabetic drug orders by pharmacists

Robert,

Quindroit,

Henry

et al. 2023

Brit J Clinical Pharma

Self Cite

View full text Add to dashboard Cite

AimThe objective of the study was to describe the impact of a clinical decision support system (CDSS) on antidiabetic drug management by clinical pharmacists for hospitalized patients with T2DM.MethodsWe performed a retrospective, single‐center study in a teaching hospital, where clinical pharmacists analyzed prescriptions and issued pharmacist interventions (PIs) through a computerized physician order entry (CPOE) system. A CDSS was integrated into the pharmacists’ workflow in July 2019. We analyzed PIs during two periods of interest: one before the introduction of the CDSS (from November 2018 to April 2019, PIs issued through the CPOE alone) and one afterwards (from November 2020 to April 2021, PIs issued through the CPOE and/or the CDSS). The study covered non‐diabetology wards as endocrinology, diabetes and metabolism departments were not computerized at the time of the study.ResultsThere were 203 PIs related to antidiabetic drugs in period 1 and 319 in period 2 (a 57.5% increase). Sixty‐four of the 319 PIs were generated by the CDSS. Noncompliance/contraindication was the main problem identified by the CDSS (41 PIs, 68.4%), and 57.8% led to discontinuation of the drug. Most of the PIs issued through the CDSS corresponded to orders that had not been flagged up by clinical pharmacists using the CPOE. Conversely, most alerts about indications that were not being treated were detected by the clinical pharmacists using the CPOE and not by the CDSS.ConclusionUse of CDSS by clinical pharmacists improved antidiabetic drug management for hospitalized patients with T2DM. The CDSS might add value to diabetes care in non‐diabetology wards by decreasing the frequency of potentially inappropriate prescriptions and adverse drug reactions.

show abstract

“…A method for developing explicit definitions of PIPADs in patients with T2DM has been published previously [ 23 ]. The present systematic review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [ 24 , 25 ].…”

Section: Methodsmentioning

confidence: 99%

“…Our present results highlight the need to establish an expert consensus on PIPAD definitions that can be translated explicitly (via a qualitative study and a Delphi survey) and applied to patients with T2DM. Next to the systematic review, the qualitative study will aim to identify as PLOS ONE many explicit definitions as possible, then the Delphi survey will aim to provide a consensus among them as show as in our published protocol [23]. Most strategies for prescribing ADs are based on guidelines and expert's opinion with implicit definitions.…”

Section: The Value Of Explicit Definitionsmentioning

confidence: 99%

Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review

Gerard¹,

Quindroit²,

Lemaître

et al. 2022

PLoS ONE

Self Cite

View full text Add to dashboard Cite

Introduction Potentially inappropriate prescriptions (PIPs) of antidiabetic drugs (ADs) (PIPADs) to patients with type 2 diabetes mellitus (T2DM) have been reported in some studies. The detection of PIPs in electronic databases requires the development of explicit definitions. This approach is widely used in geriatrics but has not been extended to PIPADs in diabetes mellitus. The objective of the present literature review was to identify all explicit definitions of PIPADs in patients with T2DM. Materials and methods We performed a systematic review of the literature listed on Medline (via PubMed), Scopus, Web of Science, and, Embase between 2010 and 2021. The query included a combination of three concepts ("T2DM" AND "PIPs" AND "ADs") and featured a total of 86 keywords. Two independent reviewers selected publications, extracted explicit definitions of PIPADs, and then classified the definitions by therapeutic class and organ class. Results Of the 4,093 screened publications, 39 were included. In all, 171 mentions of PIPADs (corresponding to 56 unique explicit definitions) were identified. More than 50% of the definitions were related to either metformin (34%) or sulfonylureas (29%). More than 75% of the definitions were related to either abnormal renal function (56%) or age (22%). In addition, 20% (n = 35) mentions stated that biguanides were inappropriate in patients with renal dysfunction and 17.5% (n = 30) stated that sulfonylureas were inappropriate above a certain age. The definitions of PIPADs were heterogeneous and had various degrees of precision. Conclusion Our results showed that researchers focused primarily on the at-risk situations related to biguanide prescriptions in patients with renal dysfunction and the prescription of sulfonylureas to older people. Our systematic review of the literature revealed a lack of consensus on explicit definitions of PIPADs, which were heterogeneous and limited (in most cases) to a small number of drugs and clinical situations.

show abstract

Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol

Cited by 4 publications

References 31 publications

Prescription of oral antidiabetics in Mexico. A cross-sectional study

Prescription of oral antidiabetics in Mexico. A cross-sectional study

Implementation of a clinical decision support system for the optimization of antidiabetic drug orders by pharmacists

Defining explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A systematic review

Contact Info

Product

Resources

About