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临床决策支持系统的评估和验证,以优化 (病态) 肥胖症住院患者的剂量 - - 一项回顾性观察性研究
Lianne Brand1,2, L Mitrov-Winkelmolen3, T M Kuijper4
1Department of Clinical Pharmacology and Toxicology, Maasstad Hospital, MaasstadLab, Rotterdam, The Netherlands. l.brand@lumc.nl.
BMC medical informatics and decision making
|March 20, 2025
概括
这项研究评估了对肥胖患者的临床决策支持系统 (CDSS),发现它有效地识别了不充分的药物治疗. 然而,医生对其建议的遵守程度各不相同,需要进一步调查以获得最佳的患者护理.
科学领域:
- 临床药房 临床药房
- 药物治疗 药物治疗
- 肥胖管理 肥胖管理
背景情况:
- 肥胖会显著改变药理动力学,需要个性化药理疗建议.
- 目前的临床实践往往缺乏个性化治疗策略和对肥胖患者的监测.
- 马斯塔德医院开发了一种临床决策支持系统 (CDSS),为患有严重肥胖的患者提供量身定制的建议.
研究的目的:
- 评估CDSS在鉴定因肥胖而药物治疗不足的患者中的有效性.
- 评估CDSS产生的无关警报率.
- 调查药剂师和医生遵守CDSS产生的建议的程度.
主要方法:
- 在马斯塔德医院进行的回顾性观察研究 (2021年1月至8月).
- 包括药物:达尔特帕林,阿皮克萨班,达比加特兰,埃多克萨班,里瓦罗克萨班,万科米辛,西普罗夫洛克萨辛.
- 通过使用灵敏度,特异性,PPV,NPV评估CDSS性能,并分析过量警报和遵守.
主要成果:
- 1218个警报来自3735个药品处置处;46.6%导致了药剂师的建议.
- 观察到高灵敏度,特异性,PPV和NPV (大多100%),有些药物特异性变化.
- 过量警报范围从22.2%到56.9%,受诸如不当的vancomycin.BMI设置等因素的影响.
结论:
- 开发的CDSS有效地识别了需要药物治疗调整的 (致病性) 肥胖患者.
- 医生遵守和实际实施CDSS建议显示出显著的变化.
- 需要进一步的研究,以了解和改善CDSS建议在临床实践中的采用.
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