Background
Methods
Research questions
Partnering with decision makers
Search strategy
Study selection
Data extraction
Assessment of study quality
Assessment of CCDSS intervention effects
Outcome selection and improvement determinations
Data synthesis and analysis
Results
Study | Methods score | Indication | No. of centres/providers/patients | Process of care outcomes | CCDSS Effecta
| Patient outcomes | CCDSS Effecta
|
---|---|---|---|---|---|---|---|
Studies of drug-only interventions
| |||||||
7 | Alerts to promote appropriate drug prescribing and monitoring for patients with renal insufficiency in long-term care. | 1*/10/833 | Appropriate final drug orders. |
0
| ... |
... | |
Fortuna, 2009[18] | 10 | Alerts to consider cost when prescribing hypnotics for adults in primary and urgent care. | 14*/257/... | Change in hypnotic drug prescriptions. |
+
| ... |
... |
Lo, 2009[20] | 10 | Alerts to order laboratory tests when prescribing new medications in primary care. | 22*/366/2765 | Ordering appropriate baseline laboratory tests. |
0
| ... |
... |
Terrell, 2009[23] | 9 | Alerts to avoid inappropriate prescriptions in geriatric outpatients during discharge from emergency care. | 1/63*/5,162 | Emergency department visits resulting in prescriptions for ≥1 of the 9 targeted inappropriate medications. |
+
| ... |
... |
Gurwitz, 2008[25] | 7 | Alerts to prevent adverse drug events in long-term care. | 2*/37/1,118 | ... |
... | Adverse drug events. |
0
|
Hicks, 2008[26] | 7 | Reminders for management of hypertension in adults in primary care. | 14*/.../2,027 | Visits with adherence to guideline medication prescribing within one week. |
+
| BP controlled. |
0
|
Matheny, 2008[28] | 8 | Reminders for routine medication laboratory monitoring in primary care. | 20*/303/1,922 | Ordering appropriate laboratory tests. |
0
| ... |
... |
Reeve, 2008[30] | 8 | Reminders for use of aspirin in diabetic adults in primary care. | 52*/150/258,979 | Number of aspirin interventions in diabetic patients. |
+
| ... |
... |
Davis, 2007[32] | 9 | Alerts for appropriate prescribing for upper respiratory tract infections in paediatric outpatients. | 2/44*/12,195 | Prescriptions consistent with recommendations. |
+
| ... |
... |
Heidenreich, 2007[33] | 7 | Reminders to prescribe β-blockers for inpatients and outpatients with reduced LVEF. | 3/50/1,546* | Patients with prescriptions for any β-blocker over nine months. |
+
| Survival free of heart failure hospitalization at one year. |
0
|
9 | Reminders for prescribing of antibiotics and drugs for asthma, COPD, and dyslipidaemia. | 23*/53/3,496 | Sum scores for appropriate prescribing of antibiotics, statins, cholesterol-lowering drugs or drugs for asthma or COPD. |
0
| ... |
... | |
Peterson, 2007[35] | 4 | Dosing advice for high-risk drugs in geriatric patients in a tertiary care academic health centre. | 1/778/2,981* | Ratio of overall prescribed to recommended doses. |
+
| ... |
... |
Raebel, 2007a[37] | 8 | Alerts to review potentially inappropriate prescriptions in ambulatory geriatric patients. | 21/.../59,680* | Dispensings of targeted potentially inappropriate medications. |
+
| ... |
... |
Raebel, 2007b[36] | 7 | Alerts to avoid teratogenic drugs in pregnant ambulatory patients. | .../.../11,100* | Dispensed category D or X drugs. |
+
| ... |
... |
Thomson, 2007[38] | 8 | Presented information for treatment decisions about warfarin or aspirin therapy for patients with atrial fibrillation in primary care. | 2/2/109* | Difference in decision conflict scale score immediately post-clinic. |
+
| Admission to hospital; adverse events including transient ischemic attack, bleeding or stroke followed by general practitioner consultation or admission; patient anxiety. |
0
|
Verstappen, 2007[39] | 6 | Management of methotrexate for early rheumatoid arthritis in adult outpatients. | 6/.../299* | ... |
... | Patients in remission for ≥3 months in first two years. |
+
|
10 | Alerts to order laboratory tests when prescribing new medications in primary care. | 15*/200/961 | Baseline laboratory monitoring completed by day 25. |
+
| ... |
... | |
Judge, 2006[42] | 8 | Alerts to avoid inappropriate prescriptions in long-term care. | 1*/27/445 | Appropriate prescriber response to alerts. |
0
| ... |
... |
Kattan, 2006[43] | 8 | Feedback provided for management of drug therapy for severe asthma in paediatric outpatients. | .../435/937* | Time to compliance with recommended therapy step; visits resulting in medication step-up after step-up recommendation. |
+
| Maximum symptom days per two weeks. |
0
|
Palen, 2006[47] | 9 | Reminders for laboratory monitoring based on medication orders in primary care. | 16/207*/26,586 | Overall compliance with ordering the recommended laboratory monitoring. |
0
| ... |
... |
Paul, 2006[48] | 10 | Recommendations for empiric antibiotic treatment in hospital inpatients. | 15*/.../2,326 | Overall rate of appropriate antibiotic treatment. |
+
| Duration of hospital stay or fever; 30-day mortality. |
0
|
Derose, 2005[50] | 7 | Reminders to prescribe ACE-Is, angiotensin receptor blockers and/or statins in outpatients with diabetes or atherosclerosis. | .../1089/8,557* | Patients with prescriptions for at least one of ACE-I, angiotensin receptor blocker, or statin. |
+
| ... |
... |
Heidenreich, 2005[51] | 6 | Reminders to prescribe ACE-I or alternative for inpatients and outpatients with reduced LVEF. | 1/.../600* | Patients with prescriptions for ≥ moderate daily dose of ACE-I or appropriate alternative. |
0
| Mortality; renal function; creatinine; systolic BP; diastolic BP. |
0
|
Raebel, 2005[54] | 8 | Alerts to order laboratory tests when prescribing new medications in primary care. | .../.../400,000* | Laboratory test completed at time prescription is dispensed. |
+
| ... |
... |
Krall, 2004[58] | 8 | Alerts to prescribe of low dose aspirin therapy in primary care. | .../100*/10,972 | Provider response to alerts (prescribe aspirin or document contraindication). |
+
| ... |
... |
Ansari, 2003[61] | 7 | Alerts to prescribe β-blockers for patients with heart failure in primary care. | 1/74*/169 | Initiated or uptitrated and maintained on β-blockers; patients at target β-blocker dose. |
0
| Proportion of patients hospitalised or with emergency department visits; deaths. |
0
|
Filippi, 2003[62] | 7 | Reminders to prescribe acetylsalicylic acid or other antiplatelet agents to diabetic primary care patients. | .../300*/15,343 | Antiplatelet drug prescription. |
+
| ... |
... |
Tamblyn, 2003[65] | 7 | Alerts to avoid inappropriate prescriptions in geriatric outpatients. | .../107*/12,560 | Proportion of new inappropriate prescriptions; discontinuation of pre-existing inappropriate prescriptions. |
+
| ... |
... |
Weir, 2003[67] | 8 | Recommendations for appropriate prescribing of anti-platelet and/or anti-coagulant drugs following stroke or transient ischemic attack for in- and out-patients | 16*/.../1,952 | Number of optimal treatments provided and rank of therapy prescribed. |
0
| Reduction in ischemic and haemorrhagic vascular events. |
0
|
Zanetti, 2003[68] | 8 | Alert to redose prophylactic antibiotics during prolonged cardiac surgery. | 1/.../447* | Intraoperative redose of antibiotics. |
+
| Surgical-site infection. |
0
|
Christakis, 2001[73] | 5 | Recommendations for appropriate prescribing of antibiotics for otitis media in paediatric outpatients. | 1/38*/488 | Antibiotics prescribed for <10 days. |
+
| ... |
... |
Rossi, 1997[81] | 9 | Reminders to modify drug therapy in hypertensive outpatients receiving calcium channel blockers as initial therapy. | 1/71/719* | Prescription changes from a calcium channel blocker to another antihypertensive agent. |
+
| ... |
... |
Rotman, 1996[83] | 7 | Alerts to prescribe lowest cost drug alternative for adult outpatients. | 1/37*/... | Rate of clinically relevant drug interactions. |
0
| ... |
... |
McDonald, 1980[87] | 5 | Detection and management of medication-related problems in outpatients. | 1/31*/... | Response rate for reminders over five weeks. |
+
| ... |
... |
Coe, 1977[88] | 4 | Recommendations for medication management of hypertension in patients attending hypertension clinics. | 2/.../116* | ... |
... | Adequate BP control achieved. |
0
|
McDonald, 1976[89] | 2 | Recommendations for laboratory tests to detect potential medication-related events in adults attending a diabetes clinic. | 1/.../226* | Ordered required tests to monitor drug effects; appropriate response to abnormal measures. |
+
| ... |
... |
Studies of multi-faceted interventions
| |||||||
9 | Recommendations for screening and treatment of dyslipidaemia in primary care. | 59*/.../3,821 | Patients with appropriate lipid management at follow-up. |
+
| ... |
... | |
Gilutz, 2009[19] | 7 | Reminders for monitoring and treatment of dyslipidaemia in primary care patients with known coronary artery disease. | 112*/600/7,448 | Appropriate initiation, up-titration, or continuation of statin therapy; adequate lipoprotein monitoring. |
+
| Change in low-density lipoprotein level. |
+
|
Javitt, 2008[27] | 6 | Patient-specific recommendations for detecting and correcting medical errors in a health maintenance organization setting. | 1/1378/49,988* | Resolution for problems identified by care considerations by adding or stopping a drug. |
+
| ... |
... |
Quinn, 2008[29] | 6 | Recommendations for management of type 2 diabetes in primary care using remote glucose monitoring. | 3/26/30* | Medications intensified; Medication errors identified. |
+
| Change in HbA1c levels. |
+
|
Van Wyk, 2008[31] | 10 | On-demand and automatic alerts to screen and treat dyslipidaemia in primary care. | 38*/80/92,054 | Patients requiring treatment were treated. |
Auto, +
On-demand, 0
| ... |
... |
Feldstein, 2006b[40] | 8 | Reminders for monitoring and treatment of osteoporosis care in high-risk women in primary care who experienced a fracture. | 15/159/311* | Received only osteoporosis medication within 6 months of study start. |
+
| ... |
... |
Kuilboer, 2006[44] | 10 | Recommendations for monitoring and treatment of asthma and COPD in primary care. | 32*/40/156,772 | Number of prescriptions for respiratory drugs. |
0
| ... |
... |
8 | Recommendations for the management of dyslipidaemia in primary care. | 1/14/235* | Change in statin prescriptions at 1 and 12 months. |
+
| Change in low-density lipoprotein levels. |
0
| |
Cobos, 2005[49] | 10 | Recommendations for treatment, monitoring and follow-up for patients with dyslipidaemia in primary care. | 42*/.../2,221 | Assessed AST/ALT measurements or creatine kinase determinations; use of lipid-lowering drugs in patients with CHD or those without CHD and at high-risk or low-risk. |
0
| Successful management of cardiovascular risk. |
0
|
Javitt, 2005[52] | 6 | Recommendations for management of patients whose care deviates from recommended practices in primary care. | .../.../39,462* | Compliance with recommendations to add or discontinue a medication. |
+
| Hospital admissions, inpatient days, and length of hospital stay. |
+
|
Plaza, 2005[53] | 9 | Recommendations for cost-effective management of asthma in primary care. | .../20*/198 | Prescriptions of oral glucocorticoids |
+
| St. George Respiratory Questionnaire total score. |
+
|
Sequist, 2005[55] | 6 | Reminders for management of diabetes and coronary artery disease in primary care. | 20*/194/6,243 | Receipt of recommended drugs in diabetes (statins, ACE-Is in hypertension) or coronary artery disease (including aspirin, β-blocker or statin use). |
0
| ... |
... |
Tierney, 2005[56] | 9 | Recommendations for the management of asthma and chronic obstructive pulmonary disease in adults in primary care. | 4/266*/706 | Suggestions adhered to for starting, modifying or stopping bronchodilators; medication compliance; patient satisfaction with physicians and pharmacists. |
0
| SF-36 subscale scores; McMaster Asthma Quality of Life and Chronic Respiratory Disease Questionnaires overall scores; emergency department visits; hospitalizations. |
0
|
Wolfenden, 2005[57] | 7 | Reminders to provide smoking cessation interventions to patients attending non-cardiac pre-operative clinic. | 1/18/210* | Preoperative nicotine replacement therapy offered or prescribed. |
+
| ... |
... |
Murray, 2004[60] | 5 | Recommendations for treatment of hypertension in primary care. | 4/...*/712 | Compliance with all antihypertensive drug suggestions; patient satisfaction. |
0
| Overall composite quality of life score. |
0
|
Tierney, 2003[66] | 10 | Recommendations for management of heart disease in primary care. | 4*/115/706 | Adherence with care suggestions to start low-dose aspirin or antihyperlipidemic drugs, or start or increase an ACE-Is, β-blockers, diuretics, long-acting nitrates, or calcium blockers. |
0
| Quality of life (score SF-36) at 12 months; quality of life (Chronic heart disease questionnaire overall health status). |
0
|
10 | Recommendations for management of asthma or angina in adults in primary care. | 62*/.../4,506 | Prescription of β-blockers for angina patients. |
0
(angina group)
| Overall and disease-specific quality of life for angina patients. |
0
(angina group)
| |
9 | Recommendations for management of urinary tract infections in women or sore throat in primary care. | 142*/.../... | Use of antibiotics for sore throat and urinary tract infections. |
+
| ... |
... | |
Lesourd, 2002[71] | 5 | Recommendations for hormonal ovarian stimulation for infertile women in a teaching hospital. | 3/4/164* | ... |
... | Pregnancy rate. |
0
|
Selker, 2002[72] | 8 | Recommendations for thrombolytic and other reperfusion therapy in acute myocardial infarction. | 28/.../1,596* | Patients who had ST-segment elevation detected but did not have acute myocardial infarction, including those who received thrombolytic therapy and those who had contraindications; thrombolytic therapy prescribed within one hour of acute myocardial infarction. |
0
| Death, stroke, or thrombolysis-related bleeding events that required transfusion within 30 days follow-up. |
0
|
Dexter, 2001[74] | 10 | Reminders for preventive therapies in hospital inpatients. | ...*/202/3,416 | Hospitalizations with an order for prophylactic heparin or aspirin at discharge (all patients and only eligible patients). |
+
| ... |
... |
McCowan, 2001[75] | 8 | Recommendations and reminders for management of asthma in primary care. | ...*/46/477 | Received prescription for acute asthma exacerbations. |
+
| Acute exacerbation of asthma. |
+
|
Demakis, 2000[76] | 7 | Reminders for screening, monitoring, and counselling in accordance with predefined standards of care in ambulatory care. | 12*/275/12,989 | Adherence to recommendations for international normalised ratio monitoring in warfarin users, anticoagulation in atrial fibrillation, β-blocker following myocardial infarction or change in non-steroidal anti-inflammatory drug therapy following gastrointestinal bleed. |
0
| ... |
... |
8 | Recommendations for diagnosis and management of hypertension, diabetes mellitus, and dyslipidaemia in primary care. | 56*/56/3,273 | ... |
... | For hypertension and diabetic patients, change at 21 months in systolic and diastolic BP, serum cholesterol, BMI, proportion of smokers, CHD risk score (women or men), proportion of patients with cardiovascular inheritance, or HbA1c level (diabetic patients only). |
0
| |
Overhage, 1997[80] | 8 | Recommendations for corollary orders to prevent errors of omission for tests and treatments in general medicine inpatients. | 1*/92/2,181 | Pharmacist interventions with physicians for significant errors. |
+
| Days in hospital; maximum serum creatinine level during hospital stay. |
0
|
Overhage, 1996[82] | 10 | Reminders to comply with 22 US Preventive Services Task Force preventive care measures for hospital inpatients. | 1*/78/1,622 | Compliance with preventive care guidelines for use of aspirin, oestrogen or calcium, ACE-Is, heparin prophylaxis, and β-blockers. |
0
| ... |
... |
Tierney, 1993[84] | 10 | Alerts for drug allergies and drug-drug interactions, and options for cost-effective testing in inpatients. | 6*/276/5,219 | ... |
... | Length of hospital stay and resource use after discharge (outpatient visits and readmissions). |
0
|
Mazzuca, 1990[85] | 7 | Reminders for the management of type 2 diabetes mellitus in outpatients. | 4*/114/279 | Initiation of oral hypoglycaemic therapy. |
0
| ... |
... |
McAlister, 1986[86] | 7 | Recommendations for management of hypertension in primary care. | 50/50*/2,231 | Patients receiving treatment for hypertension. |
0
| Diastolic BP ≤90 mmHg on last visit; days with diastolic BP ≤90 mmHg; change in diastolic BP from baseline. |
0
|