Abstract
BackgroundClinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. This study was therefore conducted to examine the effects of various CDSSs on physician practice performance and patient outcomes.MethodsThis systematic review was carried out by searching PubMed, Embase, Web of Science, Scopus, and Cochrane Library from 2005 to 2019. The studies were independently reviewed by two researchers. Any discrepancies in the eligibility of the studies between the two researchers were then resolved by consulting the third researcher. In the next step, we performed a meta-analysis based on medication subgroups, CDSS-type subgroups, and outcome categories. Also, we provided the narrative style of the findings. In the meantime, we used a random-effects model to estimate the effects of CDSS on patient outcomes and physician practice performance with a 95% confidence interval. Q statistics and I2 were then used to calculate heterogeneity.ResultsOn the basis of the inclusion criteria, 45 studies were qualified for analysis in this study. CDSS for prescription drugs/COPE has been used for various diseases such as cardiovascular diseases, hypertension, diabetes, gastrointestinal and respiratory diseases, AIDS, appendicitis, kidney disease, malaria, high blood potassium, and mental diseases. In the meantime, other cases such as concurrent prescribing of multiple medications for patients and their effects on the above-mentioned results have been analyzed. The study shows that in some cases the use of CDSS has beneficial effects on patient outcomes and physician practice performance (std diff in means = 0.084, 95% CI 0.067 to 0.102). It was also statistically significant for outcome categories such as those demonstrating better results for physician practice performance and patient outcomes or both. However, there was no significant difference between some other cases and traditional approaches. We assume that this may be due to the disease type, the quantity, and the type of CDSS criteria that affected the comparison. Overall, the results of this study show positive effects on performance for all forms of CDSSs.ConclusionsOur results indicate that the positive effects of the CDSS can be due to factors such as user-friendliness, compliance with clinical guidelines, patient and physician cooperation, integration of electronic health records, CDSS, and pharmaceutical systems, consideration of the views of physicians in assessing the importance of CDSS alerts, and the real-time alerts in the prescription.
Highlights
Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors
The findings demonstrated the effectiveness of CDSS in many diseases such as cardiovascular disease, high blood pressure, and diabetes, or cases such as simultaneous prescription of drugs
The results show that the use of CDSSs in cardiovascular patients has positive effects on physician performance by increasing the prescription of anticoagulants, Fig. 5 Forest plot of the overall effect of CDSS for prescribing on physician practice performance and patient outcome based on medication subgroup analysis after sensitivity analysis
Summary
Clinical Decision Support Systems (CDSSs) for Prescribing are one of the innovations designed to improve physician practice performance and patient outcomes by reducing prescription errors. The health care industry is influenced by factors that increase costs and reduce the quality of health services [1]. One such consideration is the prescribing errors and drug interactions that are common among medical errors; there is no need to note that avoiding such errors is of the utmost importance in preventing the side effects of drugs and other related consequences [2]. On the basis of patient circumstances, CDSS is used to coordinate complex activities from initiation to monitoring and completion of medical care as well as providing guidance to physicians [6]
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