A comparative evaluation of two clinical decision support systems for safer prescribing in older adults: an...

The geriatric population face a heightened risk of adverse drug events due to multimorbidity and polypharmacy, yet clinical decision support systems used in community pharmacies often lack explicit geriatric prescribing criteria.

This exploratory, proof-of-concept single-patient study evaluated the real-world performance of a newly developed Integrated Clinical Decision Support Tool (PIM Tool), which incorporates the EU (7)-PIM and EURO-FORTA frameworks, and compared it with e-Pharmacist, the clinical decision support module currently used in Estonia's national pharmacy system. A single patient case from the EuroAgeism dataset was analysed, with medications assessed independently in both systems.

The PIM Tool identified potentially inappropriate medications based on age, diagnosis, treatment duration, and cumulative risk, whereas e-Pharmacist primarily detected drug-drug interactions, organ-specific cautions, and dose adjustment needs. Several clinically relevant risks, including age-inappropriate long-term therapies and cumulative sedative burden, were primarily identified by the PIM Tool, while interaction-related and monitoring-related risks were captured exclusively by e-Pharmacist. Patient-reported symptoms appeared to align with overlapping risk patterns identified when outputs from both systems were considered together.

These findings suggest that clinical decision support systems based on geriatric prescribing criteria and those focused on interaction screening may capture different but complementary medication-related risks. Using both approaches together may support a more comprehensive identification of medication-related problems and deprescribing opportunities in community-dwelling older adults.