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Computerized advice on drug dosage to improve prescribing practiceDurieux P, Trinquart L, Colombet I, Niès J, Walton R, Rajeswaran A, Rège Walther M, Harvey E, Burnand B
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SummaryComputerized advice on drug dosage to improve prescribing practicePhysicians and other health care professionals often prescribe drugs that will only work at certain levels. These drugs are said to have a narrow therapeutic window. This means that if the level of the drug is too high or too low, they may cause serious side effects or not provide the benefits they should. For example, blood thinners are prescribed to thin the blood to prevent clots. If the level is too high, people can bleed to death. On the other hand, if the level is too low, a clot could form and cause a stroke. For these types of drugs, it is important that the right amount of the drug is prescribed. Calculating and prescribing the right amount can be complicated and time-consuming for health care professionals. Sometimes determining the right amount can take a long time since health professionals may not want to prescribe high doses of the drugs right away or sometimes they make mistakes. Several computer systems have been designed to do these calculations and assist health professionals to prescribe these types of drugs. A review of studies that evaluated these computer systems showed that computerized advice for drug dosage can benefit both health professionals and patients. When using the computer system, health professionals prescribed higher doses of the drugs right away and the right amount of the drug was reached quicker. Using the computer systems also reduced the length of time patients spent in the hospital while the right amount of the drug was reached. However, the computer systems did not increase or decrease how often serious side effects, such as strokes or death, occurred.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2008 Issue 3, Copyright © 2008 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 22. 2001 AbstractBackgroundMaintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in health care could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost effective fashion. This is an updated version of an earlier Cochrane systematic review, by Walton et al, published in 2001. ObjectivesTo assess whether computerised advice on drug dosage has beneficial effects on the process or outcome of health care. Search strategyWe searched the Cochrane Effective Practice and Organisation of Care Group specialized register (June 1996 to December 2006), MEDLINE (1966 to December 2006), EMBASE (1980 to December 2006), hand searched the journal Therapeutic Drug Monitoring (1979 to March 2007) and the Journal of the American Medical Informatics Association (1996 to March 2007) as well as reference lists from primary articles. Selection criteriaRandomized controlled trials, controlled trials, controlled before and after studies and interrupted time series analyses of computerized advice on drug dosage were included. The participants were health professionals responsible for patient care. The outcomes were: any objectively measured change in the behaviour of the health care provider (such as changes in the dose of drug used); any change in the health of patients resulting from computerized advice (such as adverse reactions to drugs). Data collection and analysisTwo reviewers independently extracted data and assessed study quality. Main resultsTwenty-six comparisons (23 articles) were included (as compared to fifteen comparisons in the original review) including a wide range of drugs in inpatient and outpatient settings. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses. Although all studies used reliable outcome measures, their quality was generally low. Computerized advice for drug dosage gave significant benefits by: Authors' conclusionsThis review suggests that computerized advice for drug dosage has some benefits: it increased the initial dose of drug, increased serum drug concentrations and led to a more rapid therapeutic control. It also reduced the risk of toxic drug levels and the length of time spent in the hospital. However, it had no effect on adverse reactions. In addition, there was no evidence to suggest that some decision support technical features (such as its integration into a computer physician order entry system) or aspects of organization of care (such as the setting) could optimise the effect of computerised advice. |