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Assessing the accuracy of a computerized decision support system for digoxin dosing in primary care: an observational study
Author(s) -
Kroese W. L. G.,
Avery A. J.,
Savelyich B. S. P.,
Brown N. S.,
Schers H.,
Howard R.,
HippisleyCox J.,
Horsfield P.
Publication year - 2005
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2005.00650.x
Subject(s) - digoxin , medicine , dosing , therapeutic index , therapeutic drug monitoring , observational study , drug , pharmacology , heart failure
Summary Background: This study was carried out as part of a European Union funded project (PharmDIS‐e+), to develop and evaluate software aimed at assisting physicians with drug dosing. A drug that causes particular problems with drug dosing in primary care is digoxin because of its narrow therapeutic range and low therapeutic index. Objectives: To determine (i) accuracy of the PharmDIS‐e+ software for predicting serum digoxin levels in patients who are taking this drug regularly; (ii) whether there are statistically significant differences between predicted digoxin levels and those measured by a laboratory and (iii) whether there are differences between doses prescribed by general practitioners and those suggested by the program. Methods: We needed 45 patients to have 95% Power to reject the null hypothesis that the mean serum digoxin concentration was within 10% of the mean predicted digoxin concentration. Patients were recruited from two general practices and had been taking digoxin for at least 4 months. Exclusion criteria were dementia, low adherence to digoxin and use of other medications known to interact to a clinically important extent with digoxin. Results: Forty‐five patients were recruited. There was a correlation of 0·65 between measured and predicted digoxin concentrations ( P < 0·001). The mean difference was 0·12 μ g/L (SD 0·26; 95% CI 0·04, 0·19, P = 0·005). Forty‐seven per cent of the patients were prescribed the same dose as recommended by the software, 44% were prescribed a higher dose and 9% a lower dose than recommended. Conclusion: PharmDIS‐e+ software was able to predict serum digoxin levels with acceptable accuracy in most patients.