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Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007)

, : Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007). Bmc Health Services Research 9(): 154-154

Computerised clinical decision support systems (CDSSs) are used widely to improve quality of care and patient outcomes. This systematic review evaluated the impact of CDSSs in targeting specific aspects of prescribing, namely initiating, monitoring and stopping therapy. We also examined the influence of clinical setting (institutional vs ambulatory care), system- or user-initiation of CDSS, multi-faceted vs stand alone CDSS interventions and clinical target on practice changes in line with the intent of the CDSS. We searched Medline, Embase and PsychINFO for publications from 1990-2007 detailing CDSS prescribing interventions. Pairs of independent reviewers extracted the key features and prescribing outcomes of methodologically adequate studies (experiments and strong quasi-experiments). 56 studies met our inclusion criteria, 38 addressing initiating, 23 monitoring and three stopping therapy. At the time of initiating therapy, CDSSs appear to be somewhat more effective after, rather than before, drug selection has occurred (7/12 versus 12/26 studies reporting statistically significant improvements in favour of CDSSs on = 50% of prescribing outcomes reported). CDSSs also appeared to be effective for monitoring therapy, particularly using laboratory test reminders (4/7 studies reporting significant improvements in favour of CDSSs on the majority of prescribing outcomes). None of the studies addressing stopping therapy demonstrated impacts in favour of CDSSs over comparators. The most consistently effective approaches used system-initiated advice to fine-tune existing therapy by making recommendations to improve patient safety, adjust the dose, duration or form of prescribed drugs or increase the laboratory testing rates for patients on long-term therapy. CDSSs appeared to perform better in institutional compared to ambulatory settings and when decision support was initiated automatically by the system as opposed to user initiation. CDSSs implemented with other strategies such as education were no more successful in improving prescribing than stand alone interventions. Cardiovascular disease was the most studied clinical target but few studies demonstrated significant improvements on the majority of prescribing outcomes. Our understanding of CDSS impacts on specific aspects of the prescribing process remains relatively limited. Future implementation should build on effective approaches including the use of system-initiated advice to address safety issues and improve the monitoring of therapy.


PMID: 19715591

DOI: 10.1186/1472-6963-9-154

Other references

Barnard, K.H., 1934: A new species of Goniodoris from South Africa. G. ovata*.

Razowski, J.; Becker, VO., 2000: Description of three North Andean genera of Euliini and their seven species (Lepidoptera: Tortricidae). SHILAP Revista de Lepidopterologia. 30 de marzo; 28109: 109-117

Rasin, Boris V., 2007: Informational aspects of territorial behavior of rodents and signal fields. The leading role of signal fields in the relations of rodents with the environment and particularly in territorial relations of different simpatriant species populations is depicted. It is stated that species status in ecosystem is defined not onl...

Hendrix, D.K.; Klein, T.E.; Kuntz, I.D.; Klien, T.E., 1999: Macromolecular docking of a three-body system: the recognition of human growth hormone by its receptor. Human growth hormone (hGH) binds to its receptor (hGHr) in a three-body interaction: one molecule of the hormone and two identical monomers of the receptor form a trimer. Curiously, the hormone-receptor interactions in the trimer are not equivalen...

Tulikov, A.M., 1976: Separation of weed seeds from the mineral soil fraction by the parachute method. Sandy soil that remains on the 0.25 mm, square-mesh screen after washing away clay soil particles is separated into not less than 6 fractions. A set of 5 punched roundmesh sieves (2.0; 1.25; 1.0; 0.75 and 0.5 mm) and one 0.25 mm square mesh screen...

Winkler, G.C., 1988: Pulmonary intravascular macrophages in domestic animal species: review of structural and functional properties. In dogs, laboratory animals, and man, the clearance of bacteria and particulates from blood occurs predominantly in hepatic Kupffer cells and splenic macrophages. In contrast, removal of blood-borne particulates in calves, sheep, goats, cats, and...

Anonymous, 1980: Meeting reports. Journal of Automatic Chemistry 2(3): 163-164

Anonymous, 1927: Quarantine on Account of the European Corn Borer. Notice of Quarantine no. 43 (5th Revision). Rules and Regulations supplemental to Notice of Quarantine no. 43 (5th Revision). This revision, which came into force 1st March 1927, amends and supersedes the previous one and is made to cover new areas infested by Pyrausta nubilalis, Hb., including parts of Connecticut and New Jersey. No other material changes are made in th...

Narisawa, K.; Kikuchi, G., 1966: Mechanism of allylisopropylacetamide-induced increase of -aminolevulinate synthetase in rat-liver mitochondria. The effects of inhibitors of DNA synthesis on allylisopropylacetamide-induced increases of various enzymes in different subcellular fractions of rat liver were studied. The induced increase of [delta]-aminolevulinate synthetase, a mitochondria-bou...

Li, P.; Si, Y.; Liu, Y.; Guan, R-hui., 2008: Study on a high coverage of measles vaccine while high incidence of measles disease still appeared in Shaanxi province. To analyze the affecting factors on the cause of measles and measles vaccine under the high coverage of measles vaccine in Shaanxi province. Age distribution and vaccination history on measles cases were studied. Throat swabs were obtained from me...