NEW YORK (Reuters Health) – By providing automatic information on adjusting drug dosages based on renal function, a computer-based decision support system improves prescribing for hospital patients with renal insufficiency, researchers report in the December 12th issue of The Journal of the American Medical Association.
Dr. Glenn M. Chertow from the University of California, San Francisco, and colleagues compared two systems for prescribing medications to hospital patients, alternated over four consecutive 2-month periods. One system was the usual computerized order entry while the other was the same computerized order entry system plus a decision support system to help guide medication dosing.
Of the 17,828 patients who were part of the study, 7490 had renal insufficiency to some degree. There were 97,151 analyzable medication orders written on drugs that are renally cleared or nephrotoxic, the researchers report.
Sixty-seven percent of prescriptions were deemed appropriate when the decision support system was used compared with 54% when the usual system was used (p < 0.001). Prescription frequency was also more appropriate when the decision support system was used compared to the usual system (59% versus 35%, p < 0.001), Dr. Chertow's team found.
Patients who had medication prescribed when the decision support system was used had a mean hospital stay of 4.3 days, compared with 4.5 days when the usual computerized prescription system was used (p = 0.009), the investigators note. There were also no significant cost differences between the systems.
Dr. Chertow and colleagues conclude that "provision of real-time advice in drug prescription may prove to be among the most useful applications of medical informatics technology. Such applications may provide clinicians 'a better cockpit' and result in enhanced safety and increased efficiency at minimal cost, with little intrusion into practice."
JAMA 2001;286:2839-2844.
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