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Effect of a computerized decision support system on potentially inappropriate medication prescriptions for elderly patients in Thailand
Author(s) -
Prasert Vanida,
Shono Aiko,
Chanjaruporn Farsai,
Ploylearmsang Chanuttha,
Boonnan Keerataphan,
Khampetdee Apinan,
Akazawa Manabu
Publication year - 2019
Publication title -
journal of evaluation in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.737
H-Index - 73
eISSN - 1365-2753
pISSN - 1356-1294
DOI - 10.1111/jep.13065
Subject(s) - medical prescription , medicine , clinical decision support system , emergency medicine , health care , economics , economic growth , pharmacology
Rationale, aims, and objectives The prescription of potentially inappropriate medication (PIM) is a global issue associated with increased adverse drug events, mortality, and health care expenditure. Computerized decision support system (CDSS) for the detection of PIM is a novel alert system in Thailand for reducing PIM prescriptions. The aim of this study was to evaluate the effect of a CDSS on PIM prescriptions for elderly patients in Thai community hospitals. Methods The study design comprised two phases with a duration of 12 months each: pre‐CDSS implementation (October 2015‐March 2016) and post‐CDSS implementation (October 2016‐March 2017). Medical services and prescription claims data from four hospitals were used to calculate the prevalence of PIM prescriptions among elderly patients aged 60 years and older. Chi‐square tests were used to analyse changes in PIM prescriptions across hospitals post CDSS. Results The overall prevalence of PIM prescriptions post‐CDSS implementation significantly decreased from 87.7% to 74.4%. The severity of mild and moderate PIMs was significantly reduced from 71.9% to 49.0% and from 64.5% to 48.7%, respectively. All hospitals had only one severe PIM, which was hyoscine. It was reduced from 4.7% to 1.5%, but the change was not significant ( P = 0.74). The proportion of frequently prescribed PIMs in all PIM levels was significantly decreased, regardless of existing alternative medications. Conclusions Specific CDSS for PIM in community hospital setting was associated with a reduction of PIM prescription in elderly patients. This CDSS can change physician's prescription behaviour to avoid inappropriate medications.