Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Pennsylvania 19104-6021, USA.
J Am Med Inform Assoc. 2010 Jul-Aug;17(4):411-5. doi: 10.1136/jamia.2009.000695.
Studies that have looked at the effectiveness of computerized decision support systems to prevent drug-drug interactions have reported modest results because of low response by the providers to the automated alerts.
To evaluate, within an inpatient computerized physician order entry (CPOE) system, the incremental effectiveness of an alert that required a response from the provider, intended as a stronger intervention to prevent concurrent orders of warfarin and non-steroidal anti-inflammatory drugs (NSAIDs).
Randomized clinical trial of 1963 clinicians assigned to either an intervention group receiving a customized electronic alert requiring affirmative response or a control group receiving a commercially available passive alert as part of the CPOE. The study duration was 2 August 2006 to 15 December 2007.
Alert adherence was compared between study groups.
The proportion of desired ordering responses (ie, not reordering the alert-triggering drug after firing) was lower in the intervention group (114/464 (25%) customized alerts issued) than in the control group (154/560 (28%) passive alerts firing). The adjusted OR of inappropriate ordering was 1.22 (95% CI 0.69 to 2.16).
A customized CPOE alert that required a provider response had no effect in reducing concomitant prescribing of NSAIDs and warfarin beyond that of the commercially available passive alert received by the control group. New CPOE alerts cannot be assumed to be effective in improving prescribing, and need evaluation.
研究表明，计算机化决策支持系统在预防药物相互作用方面的效果并不显著，这是因为提供者对自动警报的反应较低。
在住院医师医嘱录入系统（CPOE）中评估一种需要提供者响应的警报的额外效果，这种警报旨在作为一种更强有力的干预措施，以防止同时开具华法林和非甾体抗炎药（NSAIDs）的医嘱。
对 1963 名临床医生进行了随机临床试验，他们被分配到干预组（接受需要肯定回复的定制电子警报）或对照组（作为 CPOE 的一部分接受商业可用的被动警报）。研究时间为 2006 年 8 月 2 日至 2007 年 12 月 15 日。
比较研究组之间的警报遵守情况。
干预组（发出 464 次定制警报中的 114 次）的期望医嘱回复比例（即发出警报后不再重新开触发药物的医嘱）低于对照组（发出 560 次被动警报中的 154 次）。不适当医嘱的调整 OR 为 1.22（95%CI 0.69 至 2.16）。
在控制组接受的商业上可用的被动警报之外，需要提供者响应的定制 CPOE 警报并没有降低 NSAIDs 和华法林同时开具的处方数量。不能假设新的 CPOE 警报能有效地改善处方，需要进行评估。
