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Impact of a Clinical Decision Support System on Inappropriate Prescription of Glucose-lowering Agents for Patients With Renal Insufficiency in an Ambulatory Care Setting

  • Yun-Jhe Li
    Affiliations
    Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Department of Pharmacy, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
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  • Wan-Shih Lee
    Affiliations
    Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Yuh-Lih Chang
    Affiliations
    Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Yueh-Ching Chou
    Affiliations
    Institute of Pharmacology, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

    Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
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  • Yu-Chin Chiu
    Affiliations
    Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan
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  • Chia-Chen Hsu
    Correspondence
    Address correspondence to: Chia-Chen Hsu, MS, Department of Pharmacy, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Rd, Taipei 112, Taiwan.
    Affiliations
    Department of Pharmacy, Taipei Veterans General Hospital, Taipei, Taiwan

    Department of Pharmacy, National Yang Ming Chiao Tung University, Taipei, Taiwan
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      ABSTRACT

      Purpose

      Inappropriate dosing of glucose-lowering drugs in patients with renal insufficiency can cause severe harm. This study evaluated the short- and long-term effects of clinical decision support systems (CDSS) on inappropriate prescriptions of glucose-lowering agents for patients with renal insufficiency in an ambulatory care setting.

      Methods

      This retrospective longitudinal observational study was conducted by using an electronic medical record database and the CDSS log data at Taipei Veterans General Hospital between January 1, 2015, and December 31, 2018. Outpatients who received 7 target glucose-lowering medications and had an estimated glomerular filtration rate <50 mL/min/1.73 m2 were included. Inappropriate prescriptions were defined as a dose, frequency, or daily dose of target drugs that exceeded the dosing recommendations based on renal function. Inappropriate monthly rates were calculated, and the interrupted time series analysis method was used to explore the 1- and 3-year post-implementation effects of CDSS. The major outcome measurements were the level changes and the inappropriate prescription rate trend changes after renal CDSS implementation. The acceptance rates of alerts were also analyzed.

      Findings

      A total of 141,037 drug prescriptions were obtained during the study period. In the short-term analysis, the baseline inappropriate rate for overall medications was estimated to range from 30.54% in the first month to 27.06% in month 12. The predicted inappropriate rate 12 months after implementation was 19.35%, corresponding to an estimated 28.49% [(27.06 – 19.35)/27.06] decrease in inappropriate rate. However, after long-term analysis, the predicted inappropriate rate at the end of the study (36 months after implementation) was 18.02%. A total of 27,189 alerts were generated and 628 were accepted during the study period. Thus, after short- and long-term analysis, the overall acceptance rate was 3.06% and 2.31%, respectively.

      Implications

      Implementing a CDSS for renal dosing adjustment could significantly decrease the inappropriate prescription rate of glucose-lowing agents among patients with renal insufficiency in an ambulatory setting in the short term, while the long-term effect of a CDSS is limited.

      Keywords

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