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Intervention

Professional Intervention: Reminders - computer decision support systems (drug dosing)

Definition

Patient or encounter specific information, provided on a computer screen targeting the dosage of the medication.

Effectiveness

Seven high quality reviews (Alldred, Buckley, Harvey, Heselmans, Patterson, Tawadrous, Walton) and two key reviews (Garg, Kaushal) were identified. Findings from one high quality review (Walton) indicate that computer decision support systems (CDSS) for advice on drug dosage compared with control are generally effective for change in dose, but showed mixed effects for maintaining drug levels in the therapeutic range, controlling physiologic parameters and drug safety. Results from a second high quality review (Tawadrous) show this intervention to be effective for improving drug dosage and drug safety, however, it was ineffective for improving the number of recommendations adopted by providers. One key review (Kaushal) examined the effectiveness of CDSS interventions used alone and in combination with a computer physician order entry (CPOE) system; there was insufficient evidence in the included studies to draw conclusions on the effectiveness of CPOE+CDSS on prescribing outcomes, but when used alone CDSS was generally effective for improving drug safety outcomes. Results from one high quality review (Heselmans) found the intervention to have mixed effects for prescribing outcomes and was ineffective for improving appropriate care behaviours. Findings from one key review (Garg) indicated that CDSS had mixed effects for improving appropriate drug dosage and other appropriate care outcomes. Four high quality reviews (Alldred, Buckley, Harvey, Patterson) had an insufficient number of studies to draw any conclusions about the effectiveness of the intervention.

Summary of Overall Findings from Reviews

28 reviews that evaluated the effectiveness of computerised decision support systems for drug dosing were identified. Of these, 3/5 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective.

Summary of Findings Related to Prescribing

2/4 high quality/key reviews with a sufficient number of studies to draw conclusions found this intervention to be generally effective for improving prescribing outcomes.

Reviews listed as "Summary Pending" will be analyzed, summarized and reported at a later date.

The findings will then be incorporated in the overall evidence summaries of the interventions they address.

Reviews Addressing This Intervention Quality Assessment Tool:
AMSTAR Score (of 11 points)
Alldred DP, Raynor DK, Hughes C, Barber N, Chen TF, Spoor P. Interventions to optimise prescribing for older people in care homes. Cochrane Database of Systematic Reviews 2013 2:CD009095. 9 (High)
Harvey EL, Glenny A, Kirk SF, Summerbell CD. Improving health professionals' management and the organisation of care for overweight and obese people. Cochrane Database of Systematic Reviews 2001 2:CD000984. 9 (High)
Patterson SM, Hughes C, Kerse N, Cardwell CR, Bradley MC. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database of Systematic Reviews 2012 5:CD008165. 9 (High)
Roshanov PS, You JJ, Dhaliwal J, Koff D, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team. Can computerized clinical decision support systems improve practitioners' diagnostic test ordering behavior? A decision-maker-researcher partnership systematic review. Implementation Science 2011 6 (88):88. 9
Summary Pending
Buckley BS, Byrne MC, Smith SM. Service organisation for the secondary prevention of ischaemic heart disease in primary care. Cochrane Database of Systematic Reviews 2010 3:CD006772. 8 (High)
Heselmans A, Van de Velde S, Donceel P, Aertgeerts B, Ramaekers D. Effectiveness of electronic guideline-based implementation systems in ambulatory care settings - a systematic review. Implementation Science 2009 4 (82). 8 (High)
Ivers N, Jamtvedt G, Flottorp S, Young JM, Odgaard-Jensen J, French SD, O'Brien MA, Johansen M, Grimshaw J, Oxman AD. Audit and feedback: effects on professional practice and healthcare outcomes. Cochrane Database of Systematic Reviews 2012 6:CD000259. 8
Summary Pending
Lobach D, Sanders GD, Bright TJ, Wong A, Dhurjati R, Bristow E, Bastian L, Coeytaux R, Samsa G, Hasselblad V, Williams JW, Wing L, Musty M, Kendrick AS. Enabling health care decisionmaking through clinical decision support and knowledge management. Evidence Report/Technology Assessment 2012 (203):1-784. 8
Summary Pending
Tawadrous D, Shariff SZ, Haynes RB, Iansavichus AV, Jain AK, Garg AX. Use of clinical decision support systems for kidney-related drug prescribing: a systematic review. American Journal of Kidney Diseases 2011 58 (6):903-14. 8 (High)
Walton RT, Harvey E, Dovey S, Freemantle N. Computerised advice on drug dosage to improve prescribing practice. Cochrane Database of Systematic Reviews 2001 1:CD002894. 8 (High)
de Belvis AG, Pelone F, Biasco A, Ricciardi W, Volpe M. Can primary care professionals' adherence to Evidence Based Medicine tools improve quality of care in Type 2 diabetes mellitus? A systematic review. Diabetes Research and Clinical Practice 2009 85 (2):119-31. 7 (Medium)
Divall P, Camosso-Stefinovic J, Baker R. The use of personal digital assistants in clinical decision making by health care professionals: a systematic review. Health Informatics Journal 2013 19 (1):16-28. 7
Summary Pending
Durieux P, Trinquart L, Colombet I, Nies J, Walton R, Rajeswaran A, Rege WM, Harvey E, Burnand B. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database of Systematic Reviews 2008 3:CD002894. 7 (Medium)
Glynn LG, Murphy AW, Smith SM, Schroeder K, Fahey T. Interventions used to improve control of blood pressure in patients with hypertension. Cochrane Database of Systematic Reviews 2010 3:CD005182. 7 (Medium)
McKibbon KA, Lokker C, Handler SM, Dolovich LR, Holbrook AM, O'Reilly D, Tamblyn R, Hemens BJ. Basu R. Troyan S. Roshanov PS. Archer NP. Raina P. Enabling medication management through health information technology. Agency for Healthcare Research and Quality Technical Reviews 2011 Evidence R (11-E008-EF). 7 (Medium)
Nieuwlaat R, Connolly SJ, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team. Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review. Implementation Science 2011 6 (90). 7
Summary Pending
Roshanov PS, Misra S, Gerstein HC, Garg AX, Sebaldt RJ, Mackay JA, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team. Computerized clinical decision support systems for chronic disease management: a decision-maker-researcher partnership systematic review. Implementation Science 2011 6 (92). 7
Summary Pending
Sahota N, Lloyd R, Ramakrishna A, Mackay JA, Prorok JC, Weise-Kelly L, Navarro T, Wilczynski NL, Haynes RB, CCDSS Systematic Review Team. Computerized clinical decision support systems for acute care management: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implementation Science 2011 6 (91). 7
Summary Pending
Brusamento S, Legido-Quigley H, Panteli D, Turk E, Knai C, Saliba V, Car J, McKee M, Busse R. Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU Member States: a systematic review. Health Policy 2012 107 (41700):169-183. 6
Summary Pending
Duckers M, Faber M, Cruijsberg J, Grol R, Schoonhoven L, Wensing M. Safety and risk management interventions in hospitals: a systematic review of the literature. Medical Care Research and Review 2009 66 (Suppl 6):90S-119S. 6 (Medium)
Gilbody S, Whitty P, Grimshaw J, Thomas R. Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA 2003 289 (23):3145-51. 6 (Medium)
Jamal J, McKenzie K, Clark M. The impact of health information technology on the quality of medical and health care: a systematic review. The HIM journal 2009 38 (3):26-37. 6 (Medium)
Kawamoto K, Lobach D. Clinical decision support provided within physician order entry systems: a systematic review of features effective for changing clinician behavior. AMIA Annual Symposium Proceedings 2003:361-5. 6 (Medium)
Nirantharakumar K, Chen YF, Marshall T, Webber J, Coleman JJ. Clinical decision support systems in the care of inpatients with diabetes in non-critical care setting: systematic review. Diabetic Medicine 2012 29 (6):698-708. 6
Summary Pending
Randell R, Mitchell N, Dowding D, Cullum N, Thompson C. Effects of computerized decision support systems on nursing performance and patient outcomes: a systematic review. Journal of Health Services Research & Policy 2007 12 (4):242-9. 6 (Medium)
Cleveringa FG, Gorter KJ, van den Donk M, van GJ, Rutten GE. Computerized decision support systems in primary care for type 2 diabetes patients only improve patients' outcomes when combined with feedback on performance and case management: a systematic review. Diabetes Technology & Therapeutics 2013 15 (2):180-192. 5
Summary Pending
Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, Sam J, Haynes RB. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005 293 (10):1223-38. 5 (Medium)
Hodgkinson B, Koch S, Nay R, Nichols K. Strategies to reduce medication errors with reference to older adults. International Journal of Evidence-Based Healthcare 2006 4 (1):15008. 5
Summary Pending
Kawamoto K, Houlihan CA, Balas EA, Lobach DF. Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ 2005 330 (7494):765. 5 (Medium)
Mollon B, Chong JJ, Holbrook AM, Sung M, Thabane L, Foster G. Features predicting the success of computerized decision support for prescribing: a systematic review of randomized controlled trials. BMC Medical Informatics and Decision Making 2009 9. 5 (Medium)
Pearson SA, Moxey A, Robertson J, Hains I, Williamson M, Reeve J, Newby D. Do computerised clinical decision support systems for prescribing change practice? A systematic review of the literature (1990-2007). BMC Health Services Research 2009 9:154. 5 (Medium)
Prgomet M, Georgiou A, Westbrook JI. The impact of mobile handheld technology on hospital physicians' work practices and patient care: a systematic review. Journal of the American Medical Informatics Association 2009 16 (6):792-801. 5 (Medium)
Roshanov PS, Fernandes N, Wilczynski JM, Hemens BJ, You JJ, Handler SM, Nieuwlaat R, Souza NM, Beyene J, Spall HG, Garg AX, Haynes RB. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ 2013 346:f657. 5
Summary Pending
Boonacker C, Hoes A, Dikhoff M, Schilder A, Rovers M. Interventions in health care professionals to improve treatment in children with upper respiratory tract infections. International Journal of Pediatric Otorhinolaryngology 2010 74 (10):1113-21. 4 (Medium)
Chan AJ, Chan J, Cafazzo JA, Rossos PG, Tripp T, Shojania K, Khan T, Easty AC. Order sets in health care: a systematic review of their effects. International Journal of Technology Assessment in Health Care 2012 28 (3):235-240. 4
Summary Pending
Chaudhry B, Wang J, Wu S, Maglione M, Mojica W, Roth E, Morton SC, Shekelle PG. Systematic review: impact of health information technology on quality, efficiency, and costs of medical care. Annals of Internal Medicine 2006 144 (10):742-52. 4 (Medium)
Damiani G, Pinnarelli L, Colosimo SC, Almiento R, Sicuro L, Galasso R, Sommella L, Ricciardi W. The effectiveness of computerized clinical guidelines in the process of care: a systematic review. BMC Health Services Research 2010 10:2. 4
Summary Pending
Loganathan M, Singh S, Franklin BD, Bottle A, Majeed A. Interventions to optimise prescribing in care homes: systematic review. Age and Ageing 2011 40 (2):150-162. 4 (Medium)
Mansell G, Shapley M, Jordan JL, Jordan K. Interventions to reduce primary care delay in cancer referral: a systematic review. British Journal of General Practice 2011 61 (593):e821-e835. 4 (Medium)
Meddings J, Rogers M, Macy M, Saint S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clinical Infectious Diseases 2010 51 (5):550-60. 4 (Medium)
Montgomery AA, Fahey T. A systematic review of the use of computers in the management of hypertension. Journal of Epidemiology and Community Health 1998 52 (8):520-5. 4 (Medium)
Robertson J, Walkom E, Pearson SA, Hains I, Williamsone M, Newby D. The impact of pharmacy computerised clinical decision support on prescribing, clinical and patient outcomes: a systematic review of the literature. International Journal of Pharmacy Practice 2010 18 (2):69-87. 4 (Medium)
Georgiou A, Prgomet M, Paoloni R, Creswick N, Hordern A, Walter S, Westbrook J. The effect of computerized provider order entry systems on clinical care and work processes in emergency departments: a systematic review of the quantitative literature. Annals of Emergency Medicine 2013 61 (6):644-653. Summary Pending
Gillaizeau F, Chan E, Trinquart L, Colombet I, Walton R, Rege-Walther M, Burnand B, Durieux P. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database of Systematic Reviews 2013 11:CD002894. Summary Pending
Lainer M, Mann E, Sonnichsen A. Information technology interventions to improve medication safety in primary care: a systematic review. International Journal for Quality in Health Care 2013 25 (5):590-598. Summary Pending
Okelo SO, Butz AM, Sharma R, Diette GB, Pitts SI, King TM, Linn ST, Reuben M, Chelladurai Y, Robinson KA. Interventions to modify health care provider adherence to asthma guidelines: a systematic review. Pediatrics 2013 132 (3):517-534. Summary Pending