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Randomized Controlled Trial
. 2006 Mar-Apr;13(2):171-9.
doi: 10.1197/jamia.M1961. Epub 2005 Dec 15.

Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial

Eta S Berner  1 , Thomas K Houston, Midge N Ray, Jeroan J Allison, Gustavo R Heudebert, W Winn Chatham, John I Kennedy Jr, Gerald L Glandon, Patricia A Norton, Myra A Crawford, Richard S Maisiak
Affiliations
Randomized Controlled Trial

Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial

Eta S Berner et al. J Am Med Inform Assoc. 2006 Mar-Apr.

Abstract

Objective: To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting.

Design: The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status.

Measurements: Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group.

Results: At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs.

Conclusion: PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.

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Figures

Figure 1.
Figure 1.
Flow diagram of movement through study.
Figure 2.
Figure 2.
Mean proportion of cases per physician with unsafe prescriptions for intervention and control groups at baseline and follow-up.
Figure 3.
Figure 3.
Mean proportion of cases per physician with unsafe prescriptions for intervention and control groups at baseline and follow-up when key risk factor was recorded.
Figure 4
Figure 4
See this image and copyright information in PMC

References

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