Computer-based adverse drug effects monitoring systems and the impact on patients' outcomes: A literature overview

Abstract

With the growing number of older persons, the intake of multiple medications due to multimorbidity is challenging. Polypharmacy may result in harmful drug-drug interaction. In Germany older people living in nursing homes often ingest more than nine active components per day. This results in 4.6 adverse drug effects (ADE) per 100 resident months. ADE lead to an increased risk of fall, cause increased hospital admissions and are blamed for more than 100,000 deaths per year in the US. Generally, computer based monitoring systems are increasingly applied to reduce ADE. However, an overview of direct effects of their use on patients'/residents' health related outcomes (e.g. quality of life, apathy) is lacking yet. Therefore this study aims to provide an overview of available knowledge on beneficial aspects of computer-based ADE monitoring systems. A comprehensive systematic literature research was conducted in 2012 including the electronic databases: Carelit, Gerolit, Cinahl, PsychInfo, and Pubmed. The sensitive retrieval strategy included the terms “adverse drug reaction” AND “computer*” AND “care.” English and German publications were included into the review. Included papers had to report effects of computer-based ADE monitoring systems on patients'/residents' health outcomes and/or costs. Based upon Cochrane Collaboration Guidelines the included papers were evaluated concerning their quality. The initial search yielded 161 publications. After screening title and abstract, 12 publications were included in the further analysis. Most excluded publications contained the searching terms, but did not contribute to answer the research question. Publications showed an average quality. Computer-based ADE monitoring systems can successfully be implemented in daily practice of hospitals and nursing homes. To be beneficial, physicians and nurses had to be accepted these systems. Several studies showed positive effects, including reduced re-admission rates to hospitals, medication costs and mortality rates compared to external control groups. No study is reporting effects on patients'/residents' health related outcomes. Computer-based ADE monitoring systems show benefits in the care of patients/residents. However, there is a lack of knowledge, whether they contribute to improved health-related outcomes of patients. Therefore, further research concentrated on the impact of Computer-based ADE monitoring systems on patients'/ residents' health outcomes is required.