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Electronic DDI system effect on optimal treatment in an outpatients setting: a literature review
Gydytojų klinikinių farmakologų asociacija | ||||
Gydytojų klinikinių farmakologų asociacija | Utrecht University, Utrecht, Netherlands | |||
Lietuvos sveikatos mokslų universiteto Kauno ligoninė | Gydytojų klinikinių farmakologų asociacija |
Date Issued |
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2022-06-25 |
no. 222
Computerized decision support
Background: In Lithuania, the Ministry of Health launched an initiative to reduce drug-drug interactions in the outpatient prescriptions (DDIs) via an electronic DDI alert system in 2019. The primary goal of such a system is to optimize the treatment by warning physicians about possible DDI during the prescribing process. However, previous research suggests that such systems should be used with caution since some DDIs are inevitable in clinical practice, and alerts targeting them could lead to alert fatigue, reducing compliance even for serious DDIs that could be avoided. Objectives: To determine the effect electronic DDI systems had on outpatient clinical practice. We searched for studies evaluating adverse effects before and after the electronic DDI system was introduced as a primary goal. A secondary goal was to examine the effects of using electronic DDI system overrides as a surrogate to the effectiveness of a system. Methods: A systematic literature review was conducted in MEDLINE and EMBASE up to 3 February 2022 to identify studies investigating the effect of the implementation of electronic drug-drug interaction alert systems in routine primary care practices. We excluded studies assessing specific DDIs, studies conducted in the inpatient setting and studies based on questionnaires and surveys. From the eligible studies, we extracted information on how many prescriptions were examined, how many patients were involved and how the effectiveness of such systems were measured. Results: Our search on PubMed identified 732 articles, of which 21 were included for full-text review. After full-text review 12 articles were included in the analysis. In the selected studies, 65 – 95,7% of DDI alerts were overridden. The most common reasons for overriding drug-drug interactions were “will monitor as recommended”, “patient has already tolerated combination”, “no reasonable alternative”. Only in two articles the efficacy of DDIs alerts was evaluated by assessing adverse drug interactions related to DDIs. Few articles evaluated the appropriateness of alert overrides. However, different study designs and methodology complicate the study results’ comparability that also significantly depend on DDIs selected in specific systems. Conclusions: A significant part of DDI alerts in identified studies were overridden, suggesting a need for better tailored electronic DDI alert systems.