The effectiveness of computerized drug-lab alerts: A systematic review and meta-analysis

被引：19

作者：

Bayoumi, Imaan ^{[2
,3
,11
]}

Al Balas, Mosab ^{[4
]}

Handler, Steven M. ^{[5
,6
,7
,8
]}

Dolovich, Lisa ^{[1
,2
,10
]}

Hutchison, Brian ^{[1
,2
]}

Holbrook, Anne ^{[1
,9
,10
]}

机构：

[1] McMaster Univ, Dept Clin Epidemiol & Biostat, Hamilton, ON L8S 4L8, Canada

[2] McMaster Univ, Dept Family Med, Hamilton, ON L8S 4L8, Canada

[3] Kingston Community Hlth Centres, Kingston, ON, Canada

[4] St Josephs Hlth Care Hamilton, Dept Pharm, Hamilton, ON, Canada

[5] Univ Pittsburgh, Sch Med, Dept Biomed Informat, Pittsburgh, PA USA

[6] Univ Pittsburgh, Dept Med, Div Geriatr Med, Pittsburgh, PA USA

[7] VAPHS, GRECC, Pittsburgh, PA USA

[8] VAPHS, CHERP, Pittsburgh, PA USA

[9] McMaster Univ, Dept Med, Div Clin Pharmacol & Therapeut, Hamilton, ON L8S 4L8, Canada

[10] St Josephs Healthcare Hamilton, Ctr Evaluat Med, Hamilton, ON, Canada

[11] Queens Univ, Dept Family Med, Kingston, ON K7L 3N6, Canada

来源：

INTERNATIONAL JOURNAL OF MEDICAL INFORMATICS | 2014年 / 83卷 / 06期

关键词：

Computer-assisted decision making; Computerized alerts; Drug monitoring; Drug toxicity; Systematic review; DECISION-SUPPORT-SYSTEMS; HEALTH INFORMATION-TECHNOLOGY; LABORATORY MONITORING ALERTS; PHYSICIAN ORDER ENTRY; PRIMARY-CARE; ORAL ANTICOAGULATION; AMBULATORY-CARE; PRACTITIONER PERFORMANCE; CLINICAL REMINDERS; PATIENT OUTCOMES;

D O I：

10.1016/j.ijmedinf.2014.03.003

中图分类号：

TP [自动化技术、计算机技术];

学科分类号：

0812 ;

摘要：

Background: Inadequate lab monitoring of drugs is a potential cause of ADEs (adverse drug events) which is remediable. Objectives: To determine the effectiveness of computerized drug-lab alerts to improve medication-related outcomes. Data sources: Citations from the Computerized Clinical Decision Support System Systematic Review (CCDSSR) and MMIT (Medications Management through Health Information Technology) databases, which had searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts from 1974 to March 27, 2013. Study selection: Randomized controlled trials (RCTs) of clinician-targeted computerized drug lab alerts conducted in any healthcare setting. Two reviewers performed full text review to determine study eligibility. Data abstraction: A single reviewer abstracted data and evaluated validity of included studiesusing Cochrane handbook domains. Data synthesis: Thirty-six studies met the inclusion criteria (25 single drug studies with 22,504 participants, 14 targeting anticoagulation; 11 multi-drug studies with 56,769 participants). ADEs were reported as an outcome in only four trials, all targeting anticoagulants. Computerized drug-lab alerts did not reduce ADEs (OR 0.89, 95% CI 0.79-1.00, p = 0.05), length of hospital stay (SMD 0.00, 95% CI -0.93 to 0.93, p = 0.055, 1 study), likelihood of hypoglycemia (OR 1.29, 95% CI 0.31-5.37) or likelihood of bleeding, but were associated with increased likelihood of prescribing changes (OR 1.73, 95% CI 1.21-2.47) or lab monitoring (OR 1.47, 95% confidence interval 1.12-1.94) in accordance with the alert. Conclusions: There is no evidence that computerized drug-lab alerts are associated with important clinical benefits, but there is evidence of improvement in selected clinical surrogate outcomes (time in therapeutic range for vitamin K antagonists), and changes in process outcomes (lab monitoring and prescribing decisions). (C) 2014 Elsevier Ireland Ltd. All rights reserved.

引用

页码：406 / 415

页数：10

共 68 条

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