Computerized clinical decision support systems for drug prescribing and management: A decision-maker-researcher partnership systematic review

Autor: Jean A. Mackay, Nancy L Wilczynski, Marita Tonkin, Tamara Navarro, Anne Holbrook, Lorraine Weise-Kelly, Brian J Hemens, R. Brian Haynes
Jazyk: angličtina
Předmět:
medicine.medical_specialty
Biomedical Research
Prescription Drugs
Drug-Related Side Effects and Adverse Reactions
MEDLINE
Health Informatics
030204 cardiovascular system & hematology
Global Health
Clinical decision support system
Health informatics
law.invention
Health administration
User-Computer Interface
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
law
Humans
Medicine
030212 general & internal medicine
Cooperative Behavior
Practice Patterns
Physicians'
Disease management (health)
Monitoring
Physiologic
Medicine(all)
lcsh:R5-920
Evidence-Based Medicine
business.industry
Health Policy
Health services research
Public Health
Environmental and Occupational Health
Disease Management
General Medicine
Evidence-based medicine
Consumer Behavior
Decision Support Systems
Clinical
United States
3. Good health
Family medicine
Systematic Review
lcsh:Medicine (General)
business
Algorithms
Zdroj: Implementation Science, Vol 6, Iss 1, p 89 (2011)
Implementation Science : IS
ISSN: 1748-5908
DOI: 10.1186/1748-5908-6-89
Popis: Background Computerized clinical decision support systems (CCDSSs) for drug therapy management are designed to promote safe and effective medication use. Evidence documenting the effectiveness of CCDSSs for improving drug therapy is necessary for informed adoption decisions. The objective of this review was to systematically review randomized controlled trials assessing the effects of CCDSSs for drug therapy management on process of care and patient outcomes. We also sought to identify system and study characteristics that predicted benefit. Methods We conducted a decision-maker-researcher partnership systematic review. We updated our earlier reviews (1998, 2005) by searching MEDLINE, EMBASE, EBM Reviews, Inspec, and other databases, and consulting reference lists through January 2010. Authors of 82% of included studies confirmed or supplemented extracted data. We included only randomized controlled trials that evaluated the effect on process of care or patient outcomes of a CCDSS for drug therapy management compared to care provided without a CCDSS. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive. Results Sixty-five studies met our inclusion criteria, including 41 new studies since our previous review. Methodological quality was generally high and unchanged with time. CCDSSs improved process of care performance in 37 of the 59 studies assessing this type of outcome (64%, 57% of all studies). Twenty-nine trials assessed patient outcomes, of which six trials (21%, 9% of all trials) reported improvements. Conclusions CCDSSs inconsistently improved process of care measures and seldomly improved patient outcomes. Lack of clear patient benefit and lack of data on harms and costs preclude a recommendation to adopt CCDSSs for drug therapy management.
Databáze: OpenAIRE
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