scholarly journals The effects of clinical decision support system for prescribing on patient outcomes and physician practice performance: A systematic review

2020 ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farnia Velayati ◽  
Farahnaz Sadoughi ◽  
S.J. Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Prescription Medications ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Behavior ◽  
Multiple Drugs

Abstract Background The clinical decision support systems(CDSSs) for prescription medications is one of the technologies aimed at improving physician practice behavior and patient outcomes by reducing drug prescription errors. This study was conducted to investigate the effect of various CDSSs on physician practice behavior and patient outcomes.Methods This systematic review was conducted by searching in PubMed, EMBASE, Web of Science, Scopus and Cochrane Library from January 2005 to November 2019. Two researchers independently evaluated the studies. Any discrepancies over the eligibility of the studies between the two researchers were then resolved by consulting a third researcher. Finally, data were extracted from the articles; however, we could not able to conduct meta-analysis due to the heterogeneity of the studies and the narrative form of the findings.Results Based on the inclusion criteria, 46 studies were considered eligible for the analysis in this review. The CDSS for prescription medications had been used for various diseases, namely cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, mental disease. Meanwhile, other cases such as the concurrent prescription of multiple drugs for the patient and its effects on the above-mentioned outcomes were evaluated. The analysis shows that in some cases the application of CDSS provides positive effects on patient outcomes and physician practice behaviors. No significant difference was observed in comparison between some other cases and conventional methods. We think that this could be due to the disease type, the quantity and type of CDSS requirements that influence the comparison.Conclusions Our findings suggest that the positive effects of the CDSS are due to factors such as user-friendliness, compliance with clinical guidelines, patient and doctor cooperation, integration of electronic health records, CDSS and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts and their real-time alerts in the prescription.Registration number on PROSPERO CRD42018079936.

scholarly journals The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farnia Velayati ◽  
Farahnaz Sadoughi ◽  
Seyedjafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Prescription Medications ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance ◽  
Practice Behavior

Abstract Background: The clinical decision support systems (CDSSs) for prescription medications is one of the technologies aimed at improving physician practice behavior and patient outcomes by reducing drug prescription errors. This study, thus, was conducted to investigate the effect of various CDSSs on physician practice behavior and patient outcomes.Methods: This systematic review was conducted by searching in PubMed, EMBASE, Web of Science, Scopus and Cochrane Library from 2005 to 2019. Two researchers independently evaluated the studies. Any discrepancies over the eligibility of the studies between the two researchers were then resolved by consulting a third researcher. Finally, we extracted data from the articles. Then, we conducted a meta-analysis based on medication subgroups and outcome categories; we also presented a narrative form of the findings. Meanwhile, we applied random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with 95% confidence interval. Q statistics and I2 was then used to measure heterogeneity.Results: Based on the inclusion criteria, 46 studies were considered eligible for the analysis in this review. The CDSS for prescription medications had been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental disease. Meanwhile, other cases such as the concurrent prescription of multiple drugs for patients and its effects on the above-mentioned outcomes were evaluated. The analysis shows that in some cases the application of CDSS provides positive effects on patient outcomes and physician practice behaviors. The effect was statistically significant (std diff in means =0.114, 95% CI: 0.090 to 0.138) as overall. It was also statistically significant for outcome groups such as those showing improved outcomes on physician practice performance and patient outcome or both. No significant difference was observed in comparison between some other cases and conventional methods. We think that this could be due to the disease type, the quantity, and the type of CDSS requirements that influenced the comparison. Conclusions: Our findings suggest that positive effects of the CDSS are due to factors such as user-friendliness, compliance with clinical guidelines, patient and doctor cooperation, integration of electronic health records, CDSS and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and their real-time alerts in the prescription.

scholarly journals ­The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farahnaz Sadoughi ◽  
Farnia Velayati ◽  
Seyedjafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance ◽  
Multiple Drugs

Abstract Background: The clinical decision support systems (CDSSs) for prescribing is one of the technologies aimed at improving physician practice performance and patient outcomes by reducing medication prescription errors. This study, thus, was conducted to investigate the effect of various CDSSs on physician practice performance and patient outcomes.Methods: This systematic review was conducted by searching in PubMed, EMBASE, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. Two researchers independently evaluated the studies. Any discrepancies over the eligibility of the studies between the two researchers were then resolved by consulting a third researcher. Finally, we extracted data from the articles. Then, we conducted a meta-analysis based on medication subgroups, CDSS type subgroups, and outcome categories. Also, we presented a narrative form of the findings. In the meantime, we applied random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with 95% confidence interval. Q statistics and I2 were then used to measure heterogeneity.Results: Based on the inclusion criteria, 45 studies were considered eligible for the analysis in this review. The CDSS for prescribing medications/COPE were used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. Meanwhile, other cases such as the concurrent prescription of multiple drugs for patients and its effects on the above-mentioned outcomes were evaluated. The analysis shows that in some cases the application of CDSS provides positive effects on patient outcomes and physician practice performance (std diff in means = 0.114, 95% CI: 0.090 to 0.138). Also, it was statistically significant for outcome groups such as those showing improved outcomes on physician practice performance and patient outcome or both. However, no significant difference was observed between some other cases and conventional methods. We think that this could be due to the disease type, the quantity, and the type of CDSS requirements that influenced the comparison. Overall, all types of CDSSs have positive effects on outcomes including combinational types and other types that only cause messages when appropriate and necessary.Conclusions: Our findings suggest that positive effects of the CDSS can be attributed to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

scholarly journals The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: a systematic review and meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farahnaz Sadoughi ◽  
Farnia Velayati ◽  
Seyed Jafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance

Abstract Background Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes. Methods This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity. Results On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

scholarly journals ­­The effects of clinical decision support system for prescribing medication on patient outcomes and physician practice performance: A systematic review and meta-analysis

2020 ◽  
Author(s):  
Sharare Taheri Moghadam ◽  
Farahnaz Sadoughi ◽  
Farnia Velayati ◽  
Seyedjafar Ehsanzadeh ◽  
Shayan Poursharif
Keyword(s):  
Systematic Review ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Meta Analysis ◽  
Clinical Decision ◽  
Cochrane Library ◽  
Physician Practice ◽  
Positive Effects ◽  
Practice Performance

Abstract Background: Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes.Methods: This systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity.Results: On the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI: 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs. Conclusions: Our results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.

scholarly journals Integrative review of clinical decision support for registered nurses in acute care settings

2016 ◽  
Vol 24 (2) ◽  
pp. 441-450 ◽  
Author(s):  
Karen Dunn Lopez ◽  
Sheila M Gephart ◽  
Rebecca Raszewski ◽  
Vanessa Sousa ◽  
Lauren E Shehorn ◽  
...  
Keyword(s):  
Decision Making ◽  
Decision Support ◽  
Patient Outcomes ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Care Quality ◽  
Integrative Review ◽  
Medical Decision ◽  
Original Research ◽  
Positive Effects

Objective: To report on the state of the science of clinical decision support (CDS) for hospital bedside nurses. Materials and Methods: We performed an integrative review of qualitative and quantitative peer-reviewed original research studies using a structured search of PubMed, Embase, Cumulative Index to Nursing and Applied Health Literature (CINAHL), Scopus, Web of Science, and IEEE Xplore (Institute of Electrical and Electronics Engineers Xplore Digital Library). We included articles that reported on CDS targeting bedside nurses and excluded in stages based on rules for titles, abstracts, and full articles. We extracted research design and methods, CDS purpose, electronic health record integration, usability, and process and patient outcomes. Results: Our search yielded 3157 articles. After removing duplicates and applying exclusion rules, 28 articles met the inclusion criteria. The majority of studies were single-site, descriptive or qualitative (43%) or quasi-experimental (36%). There was only 1 randomized controlled trial. The purpose of most CDS was to support diagnostic decision-making (36%), guideline adherence (32%), medication management (29%), and situational awareness (25%). All the studies that included process outcomes (7) and usability outcomes (4) and also had analytic procedures to detect changes in outcomes demonstrated statistically significant improvements. Three of 4 studies that included patient outcomes and also had analytic procedures to detect change showed statistically significant improvements. No negative effects of CDS were found on process, usability, or patient outcomes. Discussion and Conclusions: Clinical support systems targeting bedside nurses have positive effects on outcomes and hold promise for improving care quality; however, this research is lagging behind studies of CDS targeting medical decision-making in both volume and level of evidence.

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