Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des technologies de santé et des pratiques médicales, Lille, France.
Univ. Lille, CHU Lille, ULR 7365 - GRITA: Groupe de Recherche sur les formes Injectables et les Technologies Associées, Lille, France.
Br J Clin Pharmacol. 2024 Jan;90(1):239-246. doi: 10.1111/bcp.15898. Epub 2023 Sep 15.
The objective of the study was to describe the impact of a clinical decision support system (CDSS) on antidiabetic drug management by clinical pharmacists for hospitalized patients with T2DM.
We performed a retrospective, single-centre study in a teaching hospital, where clinical pharmacists analysed prescriptions and issued pharmacist interventions (PIs) through a computerized physician order entry (CPOE) system. A CDSS was integrated into the pharmacists' workflow in July 2019. We analysed PIs during 2 periods of interest: one before the introduction of the CDSS (from November 2018 to April 2019, PIs issued through the CPOE alone) and one afterwards (from November 2020 to April 2021, PIs issued through the CPOE and/or the CDSS). The study covered nondiabetology wards as endocrinology, diabetes and metabolism departments were not computerized at the time of the study.
There were 203 PIs related to antidiabetic drugs in period 1 and 319 in period 2 (a 57.5% increase). Sixty-four of the 319 PIs were generated by the CDSS. Noncompliance/contraindication was the main problem identified by the CDSS (41 PIs, 68.4%), and 57.8% led to discontinuation of the drug. Most of the PIs issued through the CDSS corresponded to orders that had not been flagged up by clinical pharmacists using the CPOE. Conversely, most alerts about indications that were not being treated were detected by the clinical pharmacists using the CPOE and not by the CDSS.
Use of CDSS by clinical pharmacists improved antidiabetic drug management for hospitalized patients with T2DM. The CDSS might add value to diabetes care in nondiabetology wards by decreasing the frequency of potentially inappropriate prescriptions and adverse drug reactions.
本研究旨在描述临床药师通过计算机化医嘱录入系统（CPOE）为 T2DM 住院患者进行糖尿病药物管理时，临床决策支持系统（CDSS）对其产生的影响。
我们在一家教学医院进行了一项回顾性单中心研究，临床药师通过 CPOE 系统分析处方并发出药师干预（PI）。CDSS 于 2019 年 7 月整合到药师的工作流程中。我们分析了两个有意义的时间段内的 PI：一个是在引入 CDSS 之前（2018 年 11 月至 2019 年 4 月，仅通过 CPOE 发出 PI），另一个是之后（2020 年 11 月至 2021 年 4 月，通过 CPOE 和/或 CDSS 发出 PI）。研究涵盖了非内分泌科病房，因为在研究期间内分泌、糖尿病和代谢科并未实现计算机化。
第 1 阶段有 203 项与抗糖尿病药物相关的 PI，第 2 阶段有 319 项（增加了 57.5%）。第 2 阶段中的 319 项 PI 中有 64 项是由 CDSS 生成的。CDSS 主要识别出不合规/禁忌的问题（41 项 PI，占 68.4%），并导致 57.8%的药物停用。通过 CDSS 发出的大多数 PI 对应于临床药师未通过 CPOE 标记的医嘱。相反，临床药师通过 CPOE 发现的未治疗的适应证警示比 CDSS 多。
临床药师使用 CDSS 改善了 T2DM 住院患者的糖尿病药物管理。CDSS 可以通过减少潜在不适当处方和药物不良反应的发生频率，为非内分泌科病房的糖尿病护理提供更多价值。
