Linkens Aimée E M J H, Kurstjens Dennis, Zwietering N Anne, Milosevic Vanja, Hurkens Kim P G M, van Nie Noémi, van de Loo Bob P A, van der Kuy P Hugo M, Spaetgens Bart
Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands.
Drugs Real World Outcomes. 2023 Sep;10(3):363-370. doi: 10.1007/s40801-023-00365-3. Epub 2023 Mar 24.
Inappropriate prescribing is associated with negative patient outcomes. In hospitalized patients, the use of Clinical Decision Support Systems (CDSSs) may reduce inappropriate prescribing and thereby improve patient-related outcomes. However, recently published large clinical trials (OPERAM and SENATOR) have shown negative results on the use of CDSSs and patient outcomes and strikingly low acceptance of recommendations.
The purpose of the present study was to investigate the use of a CDSS in a real-life clinical setting of hospitalized older patients. As such, we report on the real-life pattern of this in-hospital implemented CDSS, including (i) whether generated alerts were resolved; (ii) whether a recorded action by the pharmacist led to an improved number of resolved alerts; and (iii) the natural course of generated alerts, in particular of those in the non-intervention group; as these data are largely lacking in current studies.
Hospitalized patients, aged 60 years and older, admitted to Zuyderland Medical Centre, the Netherlands, in 2018 were included. The evaluation of the CDSS was investigated using a database used for standard care. Alongside demographic and clinical data, we also collected the total numbers of CDSS alerts, the number of alerts 'handled' by the pharmacist, those that resulted in an action by the pharmacist, and finally the outcome of the alerts at day 1 and day 3 after the alert was generated.
A total of 3574 unique hospitalized patients, mean age 76.7 (SD 8.3) years and 53% female, were included. From these patients, 8073 alerts were generated, of which 7907 (97.9% of total) were handled by the pharmacist (day 1). In 51.6% of the alerts handled by the pharmacist, an action was initiated, resulting in 36.1% of the alerts resolved after day 1, compared with 27.3% if the pharmacist did not perform an action (p < 0.001). On day 3, in 52.6% of the alerts an action by the pharmacist was initiated, resulting in 62.4% resolved alerts, compared with 48.0% when no action was performed (p < 0.001). In the category renal function, the percentages differed significantly between an action versus no action of the pharmacist at day 1 and at day 3 (16.6% vs 10.6%, p < 0.001 [day 1]; 29.8% vs 19.4%, p < 0.001 [day 3]).
This study demonstrates the pattern and natural course of clinical alerts of an in-hospital implemented CDSS in a real-life clinical setting of hospitalized older patients. Besides the already known beneficial effect of actions by pharmacists, we have also shown that many alerts become resolved without any specific intervention. As such, our study provides an important insight into the spontaneous course of resolved alerts, since these data are currently lacking in the literature.
不恰当的处方开具与不良患者结局相关。在住院患者中，使用临床决策支持系统（CDSS）可能会减少不恰当的处方开具，从而改善与患者相关的结局。然而，最近发表的大型临床试验（OPERAM和SENATOR）显示，CDSS的使用对患者结局产生了负面结果，且建议的接受度极低。
本研究的目的是调查CDSS在住院老年患者的实际临床环境中的使用情况。因此，我们报告了该院内实施的CDSS的实际使用模式，包括：（i）生成的警报是否得到解决；（ii）药剂师记录的行动是否导致解决的警报数量增加；（iii）生成警报的自然过程，特别是非干预组中的警报；因为目前的研究在很大程度上缺乏这些数据。
纳入2018年入住荷兰祖德兰德医疗中心的60岁及以上住院患者。使用用于标准护理的数据库对CDSS进行评估。除了人口统计学和临床数据外，我们还收集了CDSS警报的总数、药剂师“处理”的警报数量、导致药剂师采取行动的警报数量，以及最后在警报生成后第1天和第3天警报的结果。
共纳入3574名独特的住院患者，平均年龄76.7（标准差8.3）岁，53%为女性。从这些患者中，生成了8073条警报，其中7907条（占总数的97.9%）由药剂师在第1天处理。在药剂师处理的警报中，51.6%启动了行动，导致第1天后36.1%的警报得到解决，而药剂师未采取行动时这一比例为27.3%（p<0.001）。在第3天，52.6%的警报由药剂师采取了行动，导致62.4%的警报得到解决，而未采取行动时这一比例为48.0%（p<0.001）。在肾功能类别中，药剂师在第1天和第3天采取行动与未采取行动的百分比差异显著（16.6%对10.
