Tuesday, July 16, 2024

Study Reveals Mixed Evidence on the Effectiveness of Clinical Decision Support Systems in Medication Safety

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In a rapidly evolving healthcare landscape where medication errors significantly impact patient outcomes, the integration of computerized Clinical Decision Support Systems (CDSS) into medication processes has been a focal point. Researchers are striving to understand the full potential of CDSS in enhancing medication safety. A recent study delves into the effectiveness of these systems by categorizing and summarizing outcomes from various interventional studies in primary and long-term care settings.

Comprehensive Review of CDSS Studies

The study systematically reviewed literature from PubMed, Embase, CINAHL, and Cochrane Library, identifying 32 interventional studies that evaluated CDSS impact on medication safety and patient outcomes. Researchers meticulously extracted methodological characteristics and empirical findings, categorizing outcomes into process-related, harm-related, and cost-related. The Evidence Project risk of bias tool was employed to assess the risk of bias in these studies.

Findings and Outcome Categories

Process-related outcomes were the most frequently utilized in the studies, appearing in 31 out of 32 research works, while harm-related outcomes were present in 11 studies and cost-related outcomes in only three. A significant finding was that most studies focused on a single category of outcomes, with none incorporating all three. This focus on limited outcome categories underscores the challenges in drawing comprehensive conclusions about CDSS effectiveness.

The study highlighted that only nine out of fifteen studies with process-related outcomes demonstrated significant intervention effects, whereas harm-related outcomes showed effectiveness in just one out of five studies. This disparity suggests varying levels of CDSS impact, particularly concerning the reduction of adverse drug events (ADEs), a critical aspect of medication safety.

Implications and Recommendations

Market access considerations emerge as pivotal in understanding these findings. The limited use of cost-related outcomes suggests an oversight in evaluating the economic implications of CDSS, which is crucial for healthcare systems aiming for cost-efficiency. The heterogeneity in outcome definitions and the methodological inconsistencies further complicate the assessment of CDSS effectiveness.

Concrete Inferences:

  • Process-related outcomes dominate CDSS evaluation, but comprehensive assessment across categories is lacking.
  • Significant intervention effects are more evident in process-related outcomes than harm-related outcomes.
  • Economic evaluations in CDSS studies are underrepresented, impacting market access and adoption decisions.
  • Methodological inconsistencies hinder the comparability and generalizability of CDSS effectiveness studies.

To address these gaps, future research should adhere to established methodological guidelines and employ a balanced set of harm-, process-, and cost-related outcomes with standardized definitions. Such an approach will enhance the reliability and applicability of findings, ultimately guiding better integration of CDSS in healthcare systems.

Original Article:

BMC Med Inform Decis Mak. 2024 Jul 4;24(1):188. doi: 10.1186/s12911-024-02596-y.

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ABSTRACT

BACKGROUND: Medication errors and associated adverse drug events (ADE) are a major cause of morbidity and mortality worldwide. In recent years, the prevention of medication errors has become a high priority in healthcare systems. In order to improve medication safety, computerized Clinical Decision Support Systems (CDSS) are increasingly being integrated into the medication process. Accordingly, a growing number of studies have investigated the medication safety-related effectiveness of CDSS. However, the outcome measures used are heterogeneous, leading to unclear evidence. The primary aim of this study is to summarize and categorize the outcomes used in interventional studies evaluating the effects of CDSS on medication safety in primary and long-term care.

METHODS: We systematically searched PubMed, Embase, CINAHL, and Cochrane Library for interventional studies evaluating the effects of CDSS targeting medication safety and patient-related outcomes. We extracted methodological characteristics, outcomes and empirical findings from the included studies. Outcomes were assigned to three main categories: process-related, harm-related, and cost-related. Risk of bias was assessed using the Evidence Project risk of bias tool.

RESULTS: Thirty-two studies met the inclusion criteria. Almost all studies (n = 31) used process-related outcomes, followed by harm-related outcomes (n = 11). Only three studies used cost-related outcomes. Most studies used outcomes from only one category and no study used outcomes from all three categories. The definition and operationalization of outcomes varied widely between the included studies, even within outcome categories. Overall, evidence on CDSS effectiveness was mixed. A significant intervention effect was demonstrated by nine of fifteen studies with process-related primary outcomes (60%) but only one out of five studies with harm-related primary outcomes (20%). The included studies faced a number of methodological problems that limit the comparability and generalizability of their results.

CONCLUSIONS: Evidence on the effectiveness of CDSS is currently inconclusive due in part to inconsistent outcome definitions and methodological problems in the literature. Additional high-quality studies are therefore needed to provide a comprehensive account of CDSS effectiveness. These studies should follow established methodological guidelines and recommendations and use a comprehensive set of harm-, process- and cost-related outcomes with agreed-upon and consistent definitions.

PROSPERO REGISTRATION: CRD42023464746.

PMID:38965569 | DOI:10.1186/s12911-024-02596-y

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