Review of Computerized Clinical Decision Support Systems for Drug Monitoring
Author Information
Author(s): Robby Nieuwlaat, Stuart J. Connolly, Jean A. Mackay, Lorraine Weise-Kelly, Tamara Navarro, Nancy L. Wilczynski, Brian Haynes
Primary Institution: Population Health Research Institute, McMaster University
Hypothesis
Do CCDSSs improve process of care or patient outcomes for therapeutic drug monitoring and dosing?
Conclusion
CCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing.
Supporting Evidence
- 60% of studies showed an improvement for process of care.
- 21% of studies showed an improvement for patient outcomes.
- All evaluable studies assessing insulin dosing for glycaemic control showed an improvement.
- Meta-analysis showed CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range.
Takeaway
Computer programs can help doctors give the right amount of medicine to patients, especially for drugs that need careful monitoring, but we still need to find better ways to prove they work.
Methodology
A systematic review of randomized controlled trials assessing the effect of CCDSS on process of care or patient outcomes.
Potential Biases
Few studies randomized clinical sites, raising concerns about contamination of control groups.
Limitations
Studies were generally small and of modest quality, and effects on patient outcomes were uncertain.
Participant Demographics
Included a total of 24,627 patients across various studies.
Statistical Information
P-Value
p = 0.03
Confidence Interval
95% CI 0.46 to 11.83
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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