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Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial
Eta S Berner1, Thomas K Houston, Midge N Ray
1Department of Health Services Administration, University of Alabama at Birmingham, 1675 University Boulevard, Room 544, Birmingham, AL 35294-3361, USA. eberner@uab.edu
Journal of the American Medical Informatics Association : JAMIA
|December 17, 2005
Summary
A personal digital assistant (PDA)-based clinical decision support system (CDSS) improved nonsteroidal anti-inflammatory drug (NSAID) prescribing safety. Residents using the CDSS made fewer unsafe treatment decisions compared to those without it.
Area of Science:
- Clinical Informatics
- Pharmacovigilance
- Health Services Research
Background:
- Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely prescribed for pain and inflammation.
- NSAID use is associated with significant gastrointestinal risks.
- Ensuring safe prescribing practices for NSAIDs is a critical aspect of outpatient care.
Purpose of the Study:
- To assess the efficacy of a personal digital assistant (PDA)-based clinical decision support system (CDSS) in enhancing the safety of nonsteroidal anti-inflammatory drug (NSAID) prescribing.
- To evaluate the impact of a CDSS on reducing unsafe NSAID prescriptions in an outpatient setting.
Main Methods:
- A randomized controlled trial was conducted in a university-based resident clinic.
- Internal medicine residents were assigned to either an intervention group (receiving a PDA-based CDSS with risk assessment and treatment recommendations) or a control group.
- Unsafe prescribing was determined by a blinded clinician committee reviewing prescriptions given to standardized patients presenting with musculoskeletal symptoms.
Main Results:
- At baseline, both groups exhibited similar rates of unsafe NSAID prescriptions.
- Following the intervention, participants using the CDSS demonstrated significantly improved prescribing safety compared to the control group (0.23 vs. 0.45, p < 0.05).
- The CDSS use was associated with more thorough documentation of patient gastrointestinal risk assessment.
Conclusions:
- The implementation of a PDA-based CDSS led to a reduction in unsafe nonsteroidal anti-inflammatory drug prescribing decisions.
- Clinical decision support systems integrated into personal digital assistants can be effective tools for improving medication safety in outpatient settings.