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Linkens AEMJH, Kurstjens D, Zwietering NA, Milosevic V, Hurkens KPGM, van Nie N, van de Loo BPA, van der Kuy PHM, Spaetgens B. Clinical Decision Support Systems in Hospitalized Older Patients: An Exploratory Analysis in a Real-Life Clinical Setting. Drugs Real World Outcomes 2023; 10:363-370. [PMID: 36964279 PMCID: PMC10491559 DOI: 10.1007/s40801-023-00365-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Inappropriate prescribing is associated with negative patient outcomes. In hospitalized patients, the use of Clinical Decision Support Systems (CDSSs) may reduce inappropriate prescribing and thereby improve patient-related outcomes. However, recently published large clinical trials (OPERAM and SENATOR) have shown negative results on the use of CDSSs and patient outcomes and strikingly low acceptance of recommendations. OBJECTIVE The purpose of the present study was to investigate the use of a CDSS in a real-life clinical setting of hospitalized older patients. As such, we report on the real-life pattern of this in-hospital implemented CDSS, including (i) whether generated alerts were resolved; (ii) whether a recorded action by the pharmacist led to an improved number of resolved alerts; and (iii) the natural course of generated alerts, in particular of those in the non-intervention group; as these data are largely lacking in current studies. METHODS Hospitalized patients, aged 60 years and older, admitted to Zuyderland Medical Centre, the Netherlands, in 2018 were included. The evaluation of the CDSS was investigated using a database used for standard care. Alongside demographic and clinical data, we also collected the total numbers of CDSS alerts, the number of alerts 'handled' by the pharmacist, those that resulted in an action by the pharmacist, and finally the outcome of the alerts at day 1 and day 3 after the alert was generated. RESULTS A total of 3574 unique hospitalized patients, mean age 76.7 (SD 8.3) years and 53% female, were included. From these patients, 8073 alerts were generated, of which 7907 (97.9% of total) were handled by the pharmacist (day 1). In 51.6% of the alerts handled by the pharmacist, an action was initiated, resulting in 36.1% of the alerts resolved after day 1, compared with 27.3% if the pharmacist did not perform an action (p < 0.001). On day 3, in 52.6% of the alerts an action by the pharmacist was initiated, resulting in 62.4% resolved alerts, compared with 48.0% when no action was performed (p < 0.001). In the category renal function, the percentages differed significantly between an action versus no action of the pharmacist at day 1 and at day 3 (16.6% vs 10.6%, p < 0.001 [day 1]; 29.8% vs 19.4%, p < 0.001 [day 3]). CONCLUSION This study demonstrates the pattern and natural course of clinical alerts of an in-hospital implemented CDSS in a real-life clinical setting of hospitalized older patients. Besides the already known beneficial effect of actions by pharmacists, we have also shown that many alerts become resolved without any specific intervention. As such, our study provides an important insight into the spontaneous course of resolved alerts, since these data are currently lacking in the literature.
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Affiliation(s)
- Aimée E M J H Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands.
| | - Dennis Kurstjens
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - N Anne Zwietering
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
- Department of Geriatric Medicine, Laurentius Hospital, Roermond, The Netherlands
| | - Vanja Milosevic
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Kim P G M Hurkens
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Noémi van Nie
- Department of Research, Innovation and Funding, Zuyderland Medical Centre, Limburg, Heerlen, The Netherlands
| | | | - P Hugo M van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015 GD, Rotterdam, The Netherlands
| | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
- Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
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Linkens AEMJH, Milosevic V, van Nie N, Zwietering A, de Leeuw PW, van den Akker M, Schols JMGA, Evers SMAA, Gonzalvo CM, Winkens B, van de Loo BPA, de Wolf L, Peeters L, de Ree M, Spaetgens B, Hurkens KPGM, van der Kuy HM. Control in the Hospital by Extensive Clinical rules for Unplanned hospitalizations in older Patients (CHECkUP); study design of a multicentre randomized study. BMC Geriatr 2022; 22:36. [PMID: 35012478 PMCID: PMC8744034 DOI: 10.1186/s12877-021-02723-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background Due to ageing of the population the incidence of multimorbidity and polypharmacy is rising. Polypharmacy is a risk factor for medication-related (re)admission and therefore places a significant burden on the healthcare system. The reported incidence of medication-related (re)admissions varies widely due to the lack of a clear definition. Some medications are known to increase the risk for medication-related admission and are therefore published in the triggerlist of the Dutch guideline for Polypharmacy in older patients. Different interventions to support medication optimization have been studied to reduce medication-related (re)admissions. However, the optimal template of medication optimization is still unknown, which contributes to the large heterogeneity of their effect on hospital readmissions. Therefore, we implemented a clinical decision support system (CDSS) to optimize medication lists and investigate whether continuous use of a CDSS reduces the number of hospital readmissions in older patients, who previously have had an unplanned probably medication-related hospitalization. Methods The CHECkUP study is a multicentre randomized study in older (≥60 years) patients with an unplanned hospitalization, polypharmacy (≥5 medications) and using at least two medications from the triggerlist, from Zuyderland Medical Centre and Maastricht University Medical Centre+ in the Netherlands. Patients will be randomized. The intervention consists of continuous (weekly) use of a CDSS, which generates a Medication Optimization Profile, which will be sent to the patient’s general practitioner and pharmacist. The control group will receive standard care. The primary outcome is hospital readmission within 1 year after study inclusion. Secondary outcomes are one-year mortality, number of emergency department visits, nursing home admissions, time to hospital readmissions and we will evaluate the quality of life and socio-economic status. Discussion This study is expected to add evidence on the knowledge of medication optimization and whether use of a continuous CDSS ameliorates the risk of adverse outcomes in older patients, already at an increased risk of medication-related (re)admission. To our knowledge, this is the first large study, providing one-year follow-up data and reporting not only on quality of care indicators, but also on quality-of-life. Trial registration The trial was registered in the Netherlands Trial Register on October 14, 2018, identifier: NL7449 (NTR7691). https://www.trialregister.nl/trial/7449. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02723-8.
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Affiliation(s)
- Aimée E M J H Linkens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands. .,Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands.
| | - Vanja Milosevic
- Clinical Pharmacy, Elkerliek Hospital, Helmond, The Netherlands
| | - Noémi van Nie
- Zuyderland Medical Centre, Heerlen, Limburg, The Netherlands
| | - Anne Zwietering
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Peter W de Leeuw
- Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Institute of General Practice, Goethe University, Frankfurt am Main, Germany.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jos M G A Schols
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Department of Health Services Research and Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Silvia M A A Evers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Centre for Economic Evaluation and Machine Learning, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Carlota Mestres Gonzalvo
- Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, Limburg, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | | | | | | | - Bart Spaetgens
- Department of Internal Medicine, Division of General Internal Medicine, Section Geriatric Medicine, Maastricht University Medical Centre, PO Box 5800, 6202, AZ, Maastricht, The Netherlands.,Department of Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Kim P G M Hurkens
- Department of Internal Medicine, Geriatric Medicine, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Hugo M van der Kuy
- Department of Hospital Pharmacy, Erasmus MC, University Medical Center Rotterdam, 3015, GD, Rotterdam, The Netherlands
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