Improving Ambulatory Prescribing Safety with a Handheld Decision Support System: A Randomized Controlled Trial
| Autor: | Myra A. Crawford, Thomas K. Houston, Midge N. Ray, W. Winn Chatham, Gerald L. Glandon, Jeroan J. Allison, Gustavo R. Heudebert, Patricia A. Norton, John I. Kennedy, Eta S. Berner, Richard Maisiak |
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| Rok vydání: | 2006 |
| Předmět: |
medicine.medical_specialty
Outpatient Clinics Hospital Gastrointestinal Diseases Point-of-Care Systems MEDLINE Original Investigations Health Informatics Ambulatory Care Information Systems Risk Assessment Clinical decision support system law.invention Hospitals University Pharmacotherapy Randomized controlled trial Risk Factors law Intervention (counseling) medicine Humans Medication Errors Outpatient clinic Medical prescription business.industry Anti-Inflammatory Agents Non-Steroidal Decision Support Systems Clinical Drug Therapy Computer-Assisted Computers Handheld Ambulatory Physical therapy business |
| Zdroj: | Journal of the American Medical Informatics Association. 13:171-179 |
| ISSN: | 1527-974X 1067-5027 |
| Popis: | Objective: To evaluate the effectiveness of a personal digital assistant (PDA)–based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting. Design: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status. Measurements: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group. Results: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs. Conclusion: Participants provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS. |
| Databáze: | OpenAIRE |
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