Studies
A Randomized Trial of the Effectiveness of On-Demand versus Computer-Triggered Drug Decision Support in Primary Care
Author: Tamblyn R, Huang A, Taylor L, Kawasumi Y, Bartlett G, Grad R, Jacques A, Dawes M, Abrahamowicz M, Perreault R, Winslade N, Poissant L, Pinsonneault A
Intervention Type: Reminders to professionals, Presence and Organization of Quality Monitoring Mechanisms
Disease State: Not specific to any chronic disease
Research Objective
To determine whether there would be a greater reduction in potential prescribing problems and a lower rate of alert overrides with a customizable computer triggered drug decision support system compared to a physician on-demand decision support system
Methods
Design: Cluster randomized controlled trial that was 6 months in duration
Study sample: Physicians and patients
Intervention:
Group 1 – Intervention: MOXXI and computer-triggered alerts; physician could change alert setting, respond to alert by modifying medication and sending a message to the pharmacist. To ignore an alert, physicians had to document a reason.
Group 2 – Control: MOXXI and on-demand alerts; physician could change alert setting, respond to alert by modifying medication and sending a message to the pharmacist. Alerts were requested by the physician. Reasons for ignoring alerts were documented.
Medication Prescribing and Use Outcome(s)
- Prevalence of prescribing problems
- Number of prescribing alerts viewed by physicians
Key Results
- No significant difference in the overall prevalence of prescribing problems between the intervention and control group
- Significant (57%) reduction in the prevalence of therapeutic duplication errors (p<0.0001) in the computer triggered group
- Significant impact on the alerts they viewed and ignored
- Physicians viewed more alerts and responded to more prescribing problems in the intervention group
Key Implementation Issues
- Computerized drug alert systems do not take the patient’s medication history and specific characteristics (ex. renal clearance) into consideration.
- Both groups did not use computerized drug support to its full potential.
- Unable to weigh the risks compared to the benefits for drug alerts using empiric data.
- Data errors resulted in numerous false positive alerts.
Citation(s)
A Randomized Trial of the Effectiveness of On-Demand versus Computer-Triggered Drug Decision Support in Primary Care. Tamblyn, R., Huang, A., Taylor, L., Kawasumi, Y., Bartlett, G., Grad., R., Jacques, A., Dawes, M., Abrahamowicz, M., Perreault, R., Winslade, N., Poissant, L., & Pinsonneault, A. (2008). Journal of the American Medical Informatics Association, 15(4), 430-438.