Currently submitted to: Journal of Medical Internet Research
Date Submitted: Jul 6, 2019
Open Peer Review Period: Jul 8, 2019 - Jul 12, 2019
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Reducing potentially inappropriate prescriptions for older patients using computerized decision support tools- a systematic review
Older adults are more vulnerable to polypharmacy, in addition to prescriptions of potentially inappropriate medications. There are several ways to address polypharmacy to prevent its occurrence. We focused on computerized decision support tools
We reviewed the available literature to understand whether computerized decision support (CDS) tools reduce potentially inappropriate prescriptions (PIP) or medications (PIM) in older adult patients and impact health outcomes.
We conducted a systematic review by searching literature in the MEDLINE, CENTRAL, EMBASE, and Web of Science databases for interventional studies published through February 2018 to assess the impact of CDS tools on PIM/PIP in people age ≥ 65 years.
A total of 3,756 articles were identified, and 15 were included. More than half (n=9) of the studies were randomized controlled trials (RCTs), 7% (n=1) were cross-over studies, and 33% (n=5) were before and after studies. A total of 232,872 participants were included and assessed in RCTs (mean: 25,875; range: 196-72072). Intervention designs had several different features. CDS tools consistently reduced the number of PIP started and mean number of PIP per patient. CDS tools also increased PIP discontinuation and drug appropriateness. However, in several studies, statistical significance was not achieved. A meta-analysis was not possible due to the significant heterogeneity among the systems used and the definitions of outcomes.
CDS tools may reduce PIP/PIM. More RCTs assessing the impact of CDS tools that could be used both in primary health care (PHC) and secondary health care (SHC) are needed to evaluate the use of medication targets defined by Beers or STOPP criteria, adverse drug reactions, quality of life measurements, and patient and professional satisfaction with a reasonable follow-up, which could clarify the clinical usefulness of these tools
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