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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Article info
Publication history
Published online: April 03, 2022
Accepted:
March 5,
2022
Identification
Copyright
© 2022 Elsevier Inc.
