Computerized advice on drug dosage to improve prescribing practice

Area of Science:

• Clinical Informatics
• Pharmacology
• Health Services Research

Background:

• Maintaining therapeutic drug concentrations for narrow therapeutic index drugs is challenging.
• Computerized systems offer potential solutions for optimizing drug dosage.
• This is an updated Cochrane systematic review assessing the impact of computerized drug dosage advice.

Purpose of the Study:

• To evaluate the effectiveness of computerized drug dosage advice versus routine care on patient outcomes.
• To identify specific therapeutic areas where computerized decision support demonstrates benefits.

Main Methods:

• Systematic review of randomized controlled trials, non-randomized controlled trials, controlled before-and-after studies, and interrupted time series analyses.
• Searched multiple databases from 1996 to 2013, including EPOC, CENTRAL, MEDLINE, EMBASE, and CINAHL.
• Data extraction and quality assessment by two independent reviewers; results grouped by drug and effect.

Main Results:

• Computerized advice improved target peak serum concentrations and therapeutic range achievement for aminoglycoside antibiotics.
• Enhanced physiological parameter control for oral anticoagulants and insulin, and reduced stabilization time for anticoagulants.
• Significantly decreased thromboembolism events for anticoagulants and tended to reduce adverse effects for aminoglycoside antibiotics and anti-rejection drugs.

Conclusions:

• Computerized drug dosage advice shows benefits in optimizing drug concentrations, improving physiological control, and reducing specific adverse events for certain medications.
• No evidence of improved mortality or other clinical adverse events for insulin, anesthetics, anti-rejection drugs, and antidepressants.
• Results should be interpreted cautiously due to high risk of bias and heterogeneity among studies.