Diagnostic accuracy in Family Medicine residents using a clinical decision support system (DXplain): a randomized-controlled trial

Diagnosis ◽  
2018 ◽  
Vol 5 (2) ◽  
pp. 71-76 ◽  
Author(s):  
Adrian Israel Martinez-Franco ◽  
Melchor Sanchez-Mendiola ◽  
Juan Jose Mazon-Ramirez ◽  
Isaias Hernandez-Torres ◽  
Carlos Rivero-Lopez ◽  
...  
Keyword(s):  
Decision Support ◽  
Family Medicine ◽  
Diagnostic Accuracy ◽  
Clinical Decision Support ◽  
Medical Practice ◽  
Intervention Group ◽  
Diagnostic Errors ◽  
Clinical Decision ◽  
Control Group ◽  
Family Medicine Residents

Abstract Background: Clinical reasoning is an essential skill in physicians, required to address the challenges of accurate patient diagnoses. The goal of the study was to compare the diagnostic accuracy in Family Medicine residents, with and without the use of a clinical decision support tool (DXplain http://www.mghlcs.org/projects/dxplain). Methods: A total of 87 first-year Family Medicine residents, training at the National Autonomous University of Mexico (UNAM) Postgraduate Studies Division in Mexico City, participated voluntarily in the study. They were randomized to a control group and an intervention group that used DXplain. Both groups solved 30 clinical diagnosis cases (internal medicine, pediatrics, gynecology and emergency medicine) in a multiple-choice question test that had validity evidence. Results: The percent-correct score in the Diagnosis Test in the control group (44 residents) was 74.1±9.4 (mean±standard deviation) whereas the DXplain intervention group (43 residents) had a score of 82.4±8.5 (p<0.001). There were significant differences in the four knowledge content areas of the test. Conclusions: Family Medicine residents have appropriate diagnostic accuracy that can improve with the use of DXplain. This could help decrease diagnostic errors, improve patient safety and the quality of medical practice. The use of clinical decision support systems could be useful in educational interventions and medical practice.

scholarly journals Effectiveness of an Advanced Clinical Decision Support System on Clinical Decision-Making Skills in a Call Center Medication Therapy Management Pharmacy Setting: A Pilot Study

Pharmacy ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 228
Author(s):  
Jennifer M. Bingham ◽  
Veronique Michaud ◽  
Jacques Turgeon ◽  
David R. Axon
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Call Center ◽  
Intervention Group ◽  
Clinical Decision ◽  
Control Group ◽  
Clinical Recommendations ◽  
Medication Therapy ◽  
Post Test ◽  
Pharmacy Setting

(1) Background: There is limited evidence related to the efficacy of advanced clinical decision support systems (CDSS) on the quantity of high-quality clinical recommendations in a pharmacy-related medication therapy management (MTM) setting. The study aimed to assess the effect of an advanced CDSS on the quantity of relevant clinical pharmacist recommendations in a call center MTM setting. (2) Methods: This pre-test/post-test with comparator group study compared clinical skills assessment scores between certified MTM pharmacists in March 2020. A Wilcoxon Signed Rank test assessed the difference between pre- and post-test scores in both groups. (3) Results: Of 20 participants, the majority were less than 40 years old (85%) with a Doctor of Pharmacy degree (90%). Nine were female. Intervention group participants had less than three years of experience as a pharmacist. The control group had less than three years (40%) or seven to ten years (40%) of experience. There was a significant increase in intervention group scores between pre- (median = 3.0, IQR = 3.0) and post-test segments (median = 6.5, IQR = 4.0, p = 0.02). There was no significant change between control group pre- and post-test segments (p = 0.48). (4) Conclusion: Pharmacist exposure to an advanced CDSS was associated with significantly increased quantity of relevant clinical recommendations in an MTM pharmacy setting.

Effect of Clinical Decision Support Systems on the Antithrombotic Treatment for Atrial Fibrillation Patients: A Systematic Review and Meta-analysis (Preprint)

2021 ◽  
Author(s):  
Xueying Ru ◽  
Yunhui Ma ◽  
Tianhao Wang ◽  
Zhigang Pan
Keyword(s):  
Atrial Fibrillation ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Intervention Group ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Control Group ◽  
Antithrombotic Treatment

BACKGROUND Atrial fibrillation (AF) is one of the most common arrhythmogenic diseases with high risk of disability and mortality, thereby greatly reducing the quality of life. Thromboembolic prophylaxis plays an essential role in AF therapy. Clinical decision support systems (CDSS) is available for management of AF patients with regard to antithrombotic treatment. OBJECTIVE To systematically review the association between clinical decision support systems (CDSS) and the antithrombotic treatment for the management of atrial fibrillation (AF) patients. METHODS We searched the electronic databases PubMed, MEDLINE., Embase, The Cochrane Library, and Biosis Preview for published randomized controlled trials (RCTs) on the relationship between CDSS and the management of AF patients from inception to April 2021. Two researchers screened these studies independently, extracted data, assessed the risk of bias and evaluated the CDSS features. The primary outcome was the proportion of antithrombotic treatment prescriptions in agreement with recommendations in the guidelines, and the secondary outcome was stroke morbidity and the incidence of adverse events. Meta-analysis was done using Revman5.4.1 and Stata16.1. RESULTS We included six RCTs, involving 20,562 subjects (11,334 in the intervention group and 9,228 in the control group). The 14.265 subjects had a primary outcome (7,930 in the intervention group and 6,335 in the control group). The proportion of antithrombotic treatment prescriptions in agreement with recommendations in the guidelines in the intervention group was slightly higher than that in the control group (RR=1.03, 95% CI: 1.01–1.05, P<.001). Stroke morbidity was not significantly different (RR=1.07, 95% CI: 0.94–1.22, P=.33), but adverse events were lower in the intervention group than that in control group (RR=0.79, 95% CI :0.64–0.98, P=.03). We detected no publication bias for the primary outcome in the meta-analysis (P=.89 for the Egger test and P=.81 for Begg’s test). CONCLUSIONS The use of CDSS improved physicians’ compliance with AF guidelines for antithrombotic treatment and decreased adverse events, but did not lower the stroke morbidity.

scholarly journals A multifaceted clinical decision support intervention to improve adherence to thromboprophylaxis guidelines

2021 ◽  
Author(s):  
Tessa Jaspers ◽  
Marjolijn Duisenberg-van Essenberg ◽  
Barbara Maat ◽  
Marc Durian ◽  
Roy van den Berg ◽  
...  
Keyword(s):  
Decision Support ◽  
Venous Thromboembolism ◽  
Clinical Decision Support ◽  
Guideline Adherence ◽  
Intervention Group ◽  
Clinical Decision ◽  
Multifaceted Intervention ◽  
Annual Number ◽  
Post Intervention ◽  
Mobile Phone Application

AbstractBackground Venous thromboembolism is a potentially fatal complication of hospitalisation, affecting approximately 3% of non-surgical patients. Administration of low molecular weight heparins to the appropriate patients adequately decreases venous thromboembolism incidence, but guideline adherence is notoriously low. Objective To determine the effect of a multifaceted intervention on thromboprophylaxis guideline adherence. The secondary objective was to study the effect on guideline adherence specifically in patients with a high venous thromboembolism risk. As an exploratory objective, we determined how many venous thromboembolisms may be prevented. Setting A Dutch general teaching hospital. Method A prospective study with a pre- and post-intervention measurement was conducted. A multifaceted intervention, consisting of Clinical Decision Support software, a mobile phone application, monitoring of duplicate anticoagulants and training, was implemented. Guideline adherence was assessed by calculating the Padua prediction and Improve bleeding score for each patient. The number of preventable venous thromboembolisms was calculated using the incidences of venous thromboembolism in patients with and without adequate thromboprophylaxis and extrapolated to the annual number of admitted patients. Main outcome measure Adherence to thromboprophylaxis guidelines in pre- and post-intervention measurements. Results 170 patients were included: 85 in both control and intervention group. The intervention significantly increased guideline adherence from 49.4 to 82.4% (OR 4.78; 95%CI 2.37–9.63). Guideline adherence in the patient group with a high venous thromboembolism risk also increased significantly from 54.5 to 84.3% (OR 2.46; 95%CI 1.31–4.62), resulting in the potential prevention of ± 261 venous thromboembolisms per year. Conclusions Our multifaceted intervention significantly increased thromboprophylaxis guideline adherence.

scholarly journals Application of Clinical Decision Support System to Assist Breast Cancer Patients with Lifestyle Modifications during the COVID-19 Pandemic: A Randomised Controlled Trial

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2115
Author(s):  
Panos Papandreou ◽  
Aristea Gioxari ◽  
Frantzeska Nimee ◽  
Maria Skouroliakou
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Control Group ◽  
Healthy Weight ◽  
Lifestyle Modifications ◽  
Randomised Controlled

Clinical decision support systems (CDSS) are data aggregation tools based on computer technology that assist clinicians to promote healthy weight management and prevention of cardiovascular diseases. We carried out a randomised controlled 3-month trial to implement lifestyle modifications in breast cancer (BC) patients by means of CDSS during the COVID-19 pandemic. In total, 55 BC women at stages I-IIIA were enrolled. They were randomly assigned either to Control group, receiving general lifestyle advice (n = 28) or the CDSS group (n = 27), to whom the CDSS provided personalised dietary plans based on the Mediterranean diet (MD) together with physical activity guidelines. Food data, anthropometry, blood markers and quality of life were evaluated. At 3 months, higher adherence to MD was recorded in the CDSS group, accompanied by lower body weight (kg) and body fat mass percentage compared to control (p < 0.001). In the CDSS arm, global health/quality of life was significantly improved at the trial endpoint (p < 0.05). Fasting blood glucose and lipid levels (i.e., cholesterol, LDL, triacylglycerols) of the CDSS arm remained unchanged (p > 0.05) but were elevated in the control arm at 3 months (p < 0.05). In conclusion, CDSS could be a promising tool to assist BC patients with lifestyle modifications during the COVID-19 pandemic.

“Send & hold” clinical decision support rules improvement to reduce unnecessary testing of vitamins A, E, K, B1, B2, B3, B6 and C

2018 ◽  
Vol 56 (7) ◽  
pp. 1063-1070 ◽  
Author(s):  
Enrique Rodriguez-Borja ◽  
Africa Corchon-Peyrallo ◽  
Esther Barba-Serrano ◽  
Celia Villalba Martínez ◽  
Arturo Carratala Calvo
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Primary Care Physicians ◽  
Vitamin B1 ◽  
Clinical Decision ◽  
Health Department ◽  
Leadership Role ◽  
Control Group ◽  
Vitamin B3 ◽  
The Impact

Abstract Background: We assessed the impact of several “send & hold” clinical decision support rules (CDSRs) within the electronical request system for vitamins A, E, K, B1, B2, B3, B6 and C for all outpatients at a large health department. Methods: When ordered through electronical request, providers (except for all our primary care physicians who worked as a non-intervention control group) were always asked to answer several compulsory questions regarding main indication, symptomatology, suspected diagnosis, vitamin active treatments, etc., for each vitamin test using a drop-down list format. After samples arrival, tests were later put on hold internally by our laboratory information system (LIS) until review for their appropriateness was made by two staff pathologists according to the provided answers and LIS records (i.e. “send & hold”). The number of tests for each analyte was compared between the 10-month period before and after CDSRs implementation in both groups. Results: After implementation, vitamins test volumes decreased by 40% for vitamin A, 29% for vitamin E, 42% for vitamin K, 37% for vitamin B1, 85% for vitamin B2, 68% for vitamin B3, 65% for vitamin B6 and 59% for vitamin C (all p values 0.03 or lower except for vitamin B3), whereas in control group, the majority increased or remained stable. In patients with rejected vitamins, no new requests and/or adverse clinical outcome comments due to this fact were identified. Conclusions: “Send & hold” CDSRs are a promising informatics tool that can support in utilization management and enhance the pathologist’s leadership role as tests specialist.

scholarly journals The ethics of machine learning-based clinical decision support: an analysis through the lens of professionalisation theory

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nils B. Heyen ◽  
Sabine Salloch
Keyword(s):  
Machine Learning ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Medical Practice ◽  
Clinical Decision ◽  
Individual Case ◽  
Structural Features ◽  
Physician Patient Relationship ◽  
Ethical Perspective ◽  
The Individual

Abstract Background Machine learning-based clinical decision support systems (ML_CDSS) are increasingly employed in various sectors of health care aiming at supporting clinicians’ practice by matching the characteristics of individual patients with a computerised clinical knowledge base. Some studies even indicate that ML_CDSS may surpass physicians’ competencies regarding specific isolated tasks. From an ethical perspective, however, the usage of ML_CDSS in medical practice touches on a range of fundamental normative issues. This article aims to add to the ethical discussion by using professionalisation theory as an analytical lens for investigating how medical action at the micro level and the physician–patient relationship might be affected by the employment of ML_CDSS. Main text Professionalisation theory, as a distinct sociological framework, provides an elaborated account of what constitutes client-related professional action, such as medical action, at its core and why it is more than pure expertise-based action. Professionalisation theory is introduced by presenting five general structural features of professionalised medical practice: (i) the patient has a concern; (ii) the physician deals with the patient’s concern; (iii) s/he gives assistance without patronising; (iv) s/he regards the patient in a holistic manner without building up a private relationship; and (v) s/he applies her/his general expertise to the particularities of the individual case. Each of these five key aspects are then analysed regarding the usage of ML_CDSS, thereby integrating the perspectives of professionalisation theory and medical ethics. Conclusions Using ML_CDSS in medical practice requires the physician to pay special attention to those facts of the individual case that cannot be comprehensively considered by ML_CDSS, for example, the patient’s personality, life situation or cultural background. Moreover, the more routinized the use of ML_CDSS becomes in clinical practice, the more that physicians need to focus on the patient’s concern and strengthen patient autonomy, for instance, by adequately integrating digital decision support in shared decision-making.

scholarly journals Clinical Decision Support and Palivizumab

2015 ◽  
Vol 06 (04) ◽  
pp. 769-784 ◽  
Author(s):  
A. Hogan ◽  
J. Michel ◽  
A.R. Localio ◽  
D. Karavite ◽  
L. Song ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Intervention Group ◽  
Clinical Decision ◽  
Partial Recovery ◽  
Patient Identification ◽  
Percentage Points ◽  
Comprehensive Intervention ◽  
Syncytial Virus ◽  
To Receive

SummaryBackground and Objectives: Palivizumab can reduce hospitalizations due to respiratory syncytial virus (RSV), but many eligible infants fail to receive the full 5-dose series. The efficacy of clinical decision support (CDS) in fostering palivizumab receipt has not been studied. We sought a comprehensive solution for identifying eligible patients and addressing barriers to palivizumab administration.Methods: We developed workflow and CDS tools targeting patient identification and palivizumab administration. We randomized 10 practices to receive palivizumab-focused CDS and 10 to receive comprehensive CDS for premature infants in a 3-year longitudinal cluster-randomized trial with 2 baseline and 1 intervention RSV seasons.Results: There were 356 children eligible to receive palivizumab, with 194 in the palivizumab-focused group and 162 in the comprehensive CDS group. The proportion of doses administered to children in the palivizumab-focused intervention group increased from 68.4% and 65.5% in the two baseline seasons to 84.7% in the intervention season. In the comprehensive intervention group, proportions of doses administered declined during the baseline seasons (from 71.9% to 62.4%) with partial recovery to 67.9% during the intervention season. The palivizumab-focused group improved by 19.2 percentage points in the intervention season compared to the prior baseline season (p < 0.001), while the comprehensive intervention group only improved 5.5 percentage points (p = 0.288). The difference in change between study groups was significant (p = 0.05).Conclusions: Workflow and CDS tools integrated in an EHR may increase the administration of palivizumab. The support focused on palivizumab, rather than comprehensive intervention, was more effective at improving palivizumab administration.

scholarly journals Minimizing Symptom-based Diagnostic Errors Using Weighted Input Variables and Fuzzy Logic Rules in Clinical Decision Support Systems

2021 ◽  
Vol 10 (3) ◽  
pp. 1567-1575
Keyword(s):  
Fuzzy Logic ◽  
Decision Support ◽  
Decision Support Systems ◽  
Clinical Decision Support ◽  
Support Systems ◽  
Diagnostic Errors ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Input Variables

ThisstudycoversanapproachtowardsminimizingDiseasediagnosticerrorsusingweightedinputvariablesandFuzzyLogicruleswithmultiphasediagnosticengine.Theweightswereappliedbecausedifferentsymptomsmayhavedifferentdegreesofimportanceindifferentdiseases.Thisistoensurethatrecommendationsfordiseaseconfirmationbasedonsymptomsreturngoodpercentageoftruepositiveandtruenegatives.Thestudycreatesanenhanced,accurateandprecisesystemformedicaldiagnosisevenwhenonlythesymptomsareconsidered.Inordertoevaluatethemodel,fourcategoriesofdiagnoseswerecarriedoutwithoutusingthemodelatthefirstinstanceandusingthemodelatthesecondinstancewith50patientsdoneat4differentdiagnosticinstances.Thetruepositive(TP)andtheFalsenegativestatisticswereobtainedfromwherethefalsepositiverate(TPR)orsensitivityandfalsepositiverate(FPR)werederived.ThegraphofTPRvsFPRwasplottedfromwherethequalityofdiagnosescouldbegottenfromtheReceiverOperatingCharacteristics(ROC)space.Theresultshowsthatsensitivity,whichistheabilityofatesttocorrectlyidentifythosewiththediseaseorTruePositiveRate,andspecificity,whichistheabilityofthetesttocorrectlyidentifythosewithoutthediseasealsocalledTrueNegativeRateTNRstoodat87%and86%respectivelyusingthedevelopedmodelandthesameparameteryielded72%and56%respectivelywithoutusingthemodel.Theresultalsoshowsthatthefalsepositiverate(FPR)whichindicatesthedegreeoffalsealarmis19%usingthenewmodelwhileitis44%withoutusingthemodel.Thisresultshowsthatthelikelihoodofmakingwrongclinicaldiagnosticdecisionsismuchlowerwiththisapproach

scholarly journals Expirience of implementation of personalized clinical decision support system for dosing of bromdihydrochlorphenylbenzodiazepine in patients with alcohol withdraw syndrome based on the pharmacogenomic markers

2020 ◽  
pp. 13-24
Author(s):  
М.С. Застрожин ◽  
А.С. Сорокин ◽  
Т.В. Агибалова ◽  
И.А. Бедина ◽  
Е.А. Гришина ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Alcohol Withdrawal ◽  
Withdrawal Syndrome ◽  
Alcohol Withdrawal Syndrome ◽  
Clinical Decision ◽  
Main Group ◽  
Control Group ◽  
Psychometric Scales ◽  
The Difference

Введение: Имплементация систем поддержки принятия решений, способных формировать рекомендации по выбору лекарствен- ного средства и его дозы в соответствии с результатами фармакогенетического тестирования, является актуальной задачей, так как решение ее позволит повысить эффективность терапии и снизить риск развития нежелательных лекарственных реакций.Материалы и методы: В исследовании принимал участие 51 пациент (21 - основная группа, получавшая назначения в соответ- ствии с рекомендациями, основанными на результатах фармакогенетического тестирования, а 30 - группа сравнения, получавшая назначения без них) мужского пола с синдромом отмены алкоголя. Для оценки эффективности и безопасности терапии синдрома отмены алкоголя, которую осуществляли с использованием бензодиазепинового транквилизатора феназепама (бромдигидрохлор- фенилбензодиазепина), а также стандартной дезинтоксикационной и витаминотерапии, применялись международные психоме- трические шкалы и шкалы оценки выраженности нежелательных реакций. Определение полиморфизмов генов CYP2D6*4 (1846G>A, rs3892097), CYP2C19*2 (681G>A, rs4244285), CYP2C19*3 (636G>A, rs4986893), CYP2C19*17 (-806C>T, rs12248560), CYP3A5*3 (6986A>G, rs776746) и ABCB1*6 (3435C>T, rs1045642) осуществлялось методом полимеразной цепной реакции в реальном времени с аллель-специфиче- ской гибридизацией. Интерпретацию результатов фармакогенетического тестирования осуществляли с использованием свободно распространяемого программного обеспечения PharmacoGenomeX2 (www.pgx2.com).Результаты: Получены статистически значимые различия в количестве баллов по всем психометрическим шкалам у пациентов основной группы и группы сравнения. Например, по шкале оценки тяжести синдрома отмены алкоголя к 3-му дню исследования количество баллов в основной группе составляло 13,5 [11,2; 16,0], а в группе контроля - 18,0 [17,0; 22,0] (p < 0,001); к 5-му в основ- ной группе - 6,5 [4,2; 8,0], в группе контроля - 15,0 [14,0; 16,0] (p < 0,001). По шкале безопасности UKU также была получена стати- стически значимая разница. К 3-му дню исследования количество баллов по шкале UKU в основной группе составило 6,0 [5,0; 7,0], а в группе контроля - 7,0 [6,0; 8,0] (p = 0,030); к 5-му дню разница возрастала. В основной группе - 5,5 [3,0; 9,0], в группе контроля - 14,0 [12,0; 19,0] (p < 0,001). Группы были репрезентативны (при включении в исследование разница в количестве баллов отсутствовала). Выводы: Персонализация дозы лекарств в соответствии с фармакогенетическими алгоритмами у пациентов с синдромом отмены алкоголя, способна снизить риск развития нежелательных реакций и фармакорезистентности, что позволяет рекомендовать исполь- зование фармакогенетических систем поддержки принятия решений для подбора дозы лекарств. Introduction: Implementation of the clinical decision support systems capable of forming the recommendations on drug and dose selec- tion according to the results of pharmacogenetic testing is an urgent task. Fulfillment of this task will allow increasing the efficacy of ther- apy and decreasing the risk of undesirable side effects.Materials and methods: The study involved 51 patients (21 - the main group receiving appointments in accordance with the recommenda- tions based on the results of pharamogenetic testing, and 30 - the comparison control group receiving appointments without them) male with alcohol withdrawal syndrome. In order to assess the effectiveness and safety of alcohol withdrawal syndrome, which was performed with the benzodiazepine tranquilizer of phenazepam (bromodihydrochlorophenylbenzodiazepine), as well as standard detoxification and vitamin therapy, international psychometric scales and scales of assessment in expressions of adverse reactions. Genotyping Determination of genetic polymorphisms CYP2D6*4 (1846G>A, rs3892097), CYP2C19*2 (681G>A, rs4244285), CYP2C19*3 (636G>A, rs4986893), CYP2C19*17 (-806C>T, rs12248560), CYP3A5*3 (6986A>G, rs776746) and ABCB1*6 (3435C>T, rs1045642) were realized using real-time polymerase chain reaction with allele specific hybridization. Interpretation of the results of pharmacogenetic testing was carried out with the help of free soft- ware PharmacoGenomeX2 (www.pgx2.com)Results: Statistically significant differences in the number of scores for all psychometric scales in the patients of the main group and the comparison group were obtained. For example, on the scale of assessing the severity of alcohol withdrawal syndrome by the 3rd day of the study, the score in the main group was 13.5 [11.2; 16,0], and in the control group - 18,0 [17,0; 22.0] (p <0.001); to the 5th in the main group - 6.5 [4.2; 8.0], in the control group - 15.0 [14.0; 16.0] (p <0.001). On the UKU security scale, a statistically significant difference was also obtained. By the 3rd day of the study, the UKU score in the main group was 6.0 [5.0; 7,0], and in the control group - 7,0 [6,0; 8.0] (p = 0.030); by the 5th day the difference increased. In the main group, 5.5 [3.0; 9.0], in the control group - 14.0 [12.0; 19.0] (p <0.001). The groups were representative (when included in the study, the difference in the number of points was absent).Conclusion: Personalization of the dose of drugs in accordance with pharmacogenetic algorithms in patients with alcohol withdrawal syn- drome, can reduce the risk of unwanted reactions and pharmacoresistance, which allows to recommend the use of pharmacogenetic deci- sion support systems for drug dosage selection.

scholarly journals Implementation of clinical decision support system for anticoagulant prescribing for patients with deep vein thrombosis

2020 ◽  
Vol 75 (1) ◽  
pp. 69-76
Author(s):  
Anton A. Chernov ◽  
E. B. Kleymenova ◽  
Dmitry A. Sychev ◽  
Liubov P. Yashina ◽  
Maria D. Nigmatkulova ◽  
...  
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Anticoagulant Therapy ◽  
Clinical Guidelines ◽  
Oral Anticoagulants ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Control Group ◽  
Hemorrhagic Complication ◽  
Vein Thrombosis

Background: Physicians adherence to recommendations for appropriate antithrombotic therapy of venous thromboembolism (VTE) can reduce the risk of recurrent VTE, pulmonary hypertension, bleeding and other adverse events. Clinical decision support systems (CDSS) are shown to increase physicians adherence to clinical guidelines. Aims: To assess effectivenes and safety of CDSS for anticoagulant prescribing for inhospital patients with VTE. Methods: A prospective cohort study was conducted in a Moscow general hospital from 06.30.2017 to 06.23.2018 to compare physicians compliance with clinical guidelines for DVT anticoagulant therapy, the rate of drug errors and direct costs of anticoagulant therapy before and after CDSS implementation (55 patients in control group and 49 in experimental group). Results: The rate of anticoagulant prescribing for patients with DVT did not alter significantly after CDSS implementation (96% compared with 91% before CDSS), but physicians compliance with recommendations on anticoagulant dosage increased from 32.7% to 73.5% (p = 0.0003) with corresponding decrease in the rate of anticoagulant prescribing errors from 1.35 to 0.65 per 1 patient (p = 0.0005). The length of stay and hemorrhagic complication rate did not differ between control and experimental groups. LMWH replacement with new oral anticoagulants has reduced the cost of anticoagulant therapy for 1 patient from 11.800 rubles (IQR = 7000) to 5.430 rubles (IQR = 5700) (p 0.005). Conclusions: СDSS can increase physicians adherence to recommended anticoagulant therapy for patients with DVT: to prevent unreasonable under-/overdosing or prolongation of anticoagulant therapy. CDSS for DVT drug therapy can be economically feasible.

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