Int J Med Inform - The effectiveness of computerized drug-lab alerts: a systematic review and meta-analysis.

Tópicos

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Resumo

CKGROUND: Inadequate lab monitoring of drugs is a potential cause of ADEs (adverse drug events) which is remediable.OBJECTIVES: To determine the effectiveness of computerized drug-lab alerts to improve medication-related outcomes.DATA SOURCES: Citations from the Computerized Clinical Decision Support System Systematic Review (CCDSSR) and MMIT (Medications Management through Health Information Technology) databases, which had searched MEDLINE, EMBASE, CINAHL, Cochrane Database of Systematic Reviews, International Pharmaceutical Abstracts from 1974 to March 27, 2013.STUDY SELECTION: Randomized controlled trials (RCTs) of clinician-targeted computerized drug lab alerts conducted in any healthcare setting. Two reviewers performed full text review to determine study eligibility.DATA ABSTRACTION: A single reviewer abstracted data and evaluated validity of included studies using Cochrane handbook domains.DATA SYNTHESIS: Thirty-six studies met the inclusion criteria (25 single drug studies with 22,504 participants, 14 targeting anticoagulation; 11 multi-drug studies with 56,769 participants). ADEs were reported as an outcome in only four trials, all targeting anticoagulants. Computerized drug-lab alerts did not reduce ADEs (OR 0.89, 95% CI 0.79-1.00, p=0.05), length of hospital stay (SMD 0.00, 95%CI -0.93 to 0.93, p=0.055, 1 study), likelihood of hypoglycemia (OR 1.29, 95% CI 0.31-5.37) or likelihood of bleeding, but were associated with increased likelihood of prescribing changes (OR 1.73, 95% CI 1.21-2.47) or lab monitoring (OR 1.47, 95% confidence interval 1.12-1.94) in accordance with the alert.CONCLUSIONS: There is no evidence that computerized drug-lab alerts are associated with important clinical benefits, but there is evidence of improvement in selected clinical surrogate outcomes (time in therapeutic range for vitamin K antagonists), and changes in process outcomes (lab monitoring and prescribing decisions).

Resumo Limpo

ckground inadequ lab monitor drug potenti caus ade advers drug event remediableobject determin effect computer druglab alert improv medicationrel outcomesdata sourc citat computer clinic decis support system systemat review ccdssr mmit medic manag health inform technolog databas search medlin embas cinahl cochran databas systemat review intern pharmaceut abstract march studi select random control trial rcts cliniciantarget computer drug lab alert conduct healthcar set two review perform full text review determin studi eligibilitydata abstract singl review abstract data evalu valid includ studi use cochran handbook domainsdata synthesi thirtysix studi met inclus criteria singl drug studi particip target anticoagul multidrug studi particip ade report outcom four trial target anticoagul computer druglab alert reduc ade ci p length hospit stay smd ci p studi likelihood hypoglycemia ci likelihood bleed associ increas likelihood prescrib chang ci lab monitor confid interv accord alertconclus evid computer druglab alert associ import clinic benefit evid improv select clinic surrog outcom time therapeut rang vitamin k antagonist chang process outcom lab monitor prescrib decis

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