Evaluation of a Clinical Decision Support System for the Identification of Inappropriate Prescription Patterns in Elderly in the Community Pharmacy Setting

Abstract

Objective: This study aimed to design and evaluate a clinical decision support system (CDSS) identifying inappropriate prescription patterns in the elderly to be used at community pharmacies. Methods: The study was carried out in 20 community pharmacies during a 6-month period on patients ≥65 years. A CDSS was developed and integrated into the pharmacy automation systems to automatically check the medications of the patients for the presence of any potentially inappropriate medications (PIMs). Depending on the preference of the pharmacist the recommendations were communicated with the prescriber or not. The number and characteristics of the PIMs, prescribers’ acceptance status of the recommendations, and usability of the CDSS were recorded. Results: During the 6-month period 1250 prescriptions each from an individual patient were evaluated. The median (interquartile range) age of the patients was 73 (63-81) years. The total number of PIMs was 1359 and 59% of the patients had at least one PIM. The most frequently identified PIMs involved proton pump inhibitors (16%) and selective beta-blockers (11.9%). The pharmacists communicated with the prescribers regarding 24.4% of the PIM-involving prescriptions and 85.8% of the prescribers accepted the recommendations. The usability of the CDSS was found to be good. Conclusion: It is anticipated that the widespread use of this product would prevent drug-related adverse events, hospitalizations, morbidities, and mortalities; thus, would improve patients’ health and quality of life, as well as lead to better clinical, humanistic, and economic outcomes.

Keywords

• clinical decision support system
• community pharmacy
• elderly
• geriatric
• potentially inappropriate medication