Open AccessJournal Article
The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care
Robyn Tamblyn,Allen Huang,Robert Perreault,André Jacques,Denis Roy,James A. Hanley,Peter J. McLeod,Réjean Laprise +7 more
TLDR
Computer-based access to complete drug profiles and alerts about potential prescribing problems reduces the rate of initiation of potentially inappropriate prescriptions but has a more selective effect on the discontinuation of such prescriptions.Abstract:
Background: Adverse drug-related events are common in the elderly, and inappropriate prescribing is a preventable risk factor. Our objective was to determine whether inappropriate prescribing could be reduced when primary care physicians had computer-based access to information on all prescriptions dispensed and automated alerts for potential prescribing problems. Methods: We randomly assigned 107 primary care physicians with at least 100 patients aged 66 years and older (total 12 560) to a group receiving computerized decision-making support (CDS) or a control group. Physicians in the CDS group had access to information on current and past prescriptions through a dedicated computer link to the provincial seniors9 drug-insurance program. When any of 159 clinically relevant prescribing problems were identified by the CDS software, the physician received an alert that identified the nature of the problem, possible consequences and alternative therapy. The rate of initiation and discontinuation of potentially inappropriate prescriptions was assessed over a 13-month period. Results: In the 2 months before the study, 31.8% of the patients in the CDS group and 33.3% of those in the control group had at least 1 potentially inappropriate prescription. During the study the number of new potentially inappropriate prescriptions per 1000 visits was significantly lower (18%) in the CDS group than in the control group (relative rate [RR] 0.82, 95% confidence interval [CI] 0.69–0.98), but differences between the groups in the rate of discontinuation of potentially inappropriate prescriptions were significant only for therapeutic duplication by the study physician and another physician (RR 1.66, 95% CI 0.99–2.79) and drug interactions caused by prescriptions written by the study physician (RR 2.15, 95% CI 0.98–4.70). Interpretation: Computer-based access to complete drug profiles and alerts about potential prescribing problems reduces the rate of initiation of potentially inappropriate prescriptions but has a more selective effect on the discontinuation of such prescriptions.read more
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Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review.
Amit X. Garg,Neill K. J. Adhikari,Heather McDonald,M. Patricia Rosas-Arellano,Philip J. Devereaux,Joseph Beyene,Justina Sam,R. Brian Haynes +7 more
TL;DR: Improvement in practitioner performance was associated with CDSSs that automatically prompted users compared with requiring users to activate the system and studies in which the authors were not the developers, as well as other factors.
Journal ArticleDOI
Appropriate prescribing in elderly people: how well can it be measured and optimised?
Anne Spinewine,Kenneth E. Schmader,Nick Barber,Carmel Hughes,Kate L. Lapane,Christian Swine,Joseph T. Hanlon +6 more
TL;DR: This work defines and categorise appropriate prescribing in elderly people, critically review the instruments that are available to measure it and discuss their predictive validity, and critically review recent randomised controlled intervention studies that assessed the effect of optimisation strategies on the appropriateness of prescribing.
Journal ArticleDOI
Effect of Clinical Decision-Support Systems: A Systematic Review
Tiffani J Bright,Anthony Wong,Ravi Dhurjati,Erin Bristow,Lori A. Bastian,Remy R Coeytaux,Gregory P. Samsa,Vic Hasselblad,John W Williams,Michael Musty,Liz Wing,Amy S Kendrick,Gillian D Sanders,David F. Lobach +13 more
TL;DR: Both commercially and locally developed CDSSs are effective at improving health care process measures across diverse settings, but evidence for clinical, economic, workload, and efficiency outcomes remains sparse.
Journal Article
Effect of Clinical Decision-Support Systems
Tiffani J Bright,Anthony Wong,Ravi Dhurjati,Erin Bristow,Lori A. Bastian,Remy R Coeytaux,Gregory P. Samsa,Vic Hasselblad,John W Williams,Michael Musty,Liz Wing,Amy S Kendrick,Gillian D Sanders,David F. Lobach +13 more
TL;DR: In this paper, a review summarizes trials of clinical decision support systems implemented in clinical settings to aid decision-making at the point-of-care (POC) level, and concludes that the evidence to support widespread use of CDSSs is lacking.
Journal ArticleDOI
Potentially inappropriate medication use among elderly home care patients in Europe
Daniela Fialová,Eva Topinkova,Giovanni Gambassi,Harriet Finne-Soveri,Palmi V. Jonsson,Iain Carpenter,Marianne Schroll,Graziano Onder,Liv Wergeland Sørbye,Cordula Wagner,Jindra Reissigová,Roberto Bernabei +11 more
TL;DR: Substantial differences in potentially inappropriate medication use exist between European countries and might be a consequence of different regulatory measures, clinical practices, or inequalities in socioeconomic background.
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