SynthesisImplementation science : IS2011
Computerized clinical decision support systems for therapeutic drug monitoring and dosing: a decision-maker-researcher partnership systematic review.
Synthesis in Implementation science : IS, 2011. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers, 7 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- How intervention studies measure the effectiveness of medication safety-related clinical decision support systems in primary and long-term care: a systematic review.BMC medical informatics and decision making · 2024Pooled it
- Systematic review of interventions to improve safety and quality of anticoagulant prescribing for therapeutic indications for hospital inpatients.European journal of clinical pharmacology · 2019Pooled it
- Impact of Information and Communication Technologies on Nursing Care: Results of an Overview of Systematic Reviews.Journal of medical Internet research · 2017Pooled it
- An Evaluation of the Effects of Human Factors and Ergonomics on Health Care and Patient Safety Practices: A Systematic Review.PloS one · 2015Pooled it
- Use of handheld computers in clinical practice: a systematic review.BMC medical informatics and decision making · 2014Pooled it
- Computer decision support systems for asthma: a systematic review.NPJ primary care respiratory medicine · 2014Pooled it
- Computerized advice on drug dosage to improve prescribing practice.The Cochrane database of systematic reviews · 2013Pooled it
- Computerized clinical decision support system for diabetes in primary care does not improve quality of care: a cluster-randomized controlled trial.Implementation science : IS · 2020 · on this mapTrial
- Combining alcohol interventions with tobacco addictions treatment in primary care-the COMBAT study: a pragmatic cluster randomized trial.Implementation science : IS · 2017Trial
- Outcomes of clinical decision support (CDS) and correlates of CDS use for home care patients with high medication regimen complexity: a randomized trial.Journal of evaluation in clinical practice · 2016Trial
- Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.Implementation science : IS · 2015Trial
- Evaluating the uptake and effects of the computerized decision support system NHGDoc on quality of primary care: protocol for a large-scale cluster randomized controlled trial.Implementation science : IS · 2014Trial
- Cluster randomized controlled trial of a simple warfarin maintenance dosing algorithm versus usual care among primary care practices.Journal of thrombosis and thrombolysis · 2014Trial
- PICO-based assessment and categorization of evidence for digital health interventions: an inductive framework development.Frontiers in digital health · 2026Review
- Bayesian Vancomycin Model Selection for Therapeutic Drug Monitoring in Neonates.Clinical pharmacokinetics · 2024Article
- Learning meaningful latent space representations for patient risk stratification: Model development and validation for dengue and other acute febrile illness.Frontiers in digital health · 2023Article
- Article
- Effects of Guideline-based Computerized Provider Order Entry Systems on the Chemotherapy Order Process: a Systematic Review.Acta informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia & Herzegovina : casopis Drustva za medicinsku informatiku BiH · 2022Review
- Development of a Fluorescent Microfluidic Device Based on Antibody Microarray Read-Out for Therapeutic Drug Monitoring of Acenocoumarol.Frontiers in bioengineering and biotechnology · 2022Article
- Clinical decision support systems-based interventions to improve medication outcomes: A systematic literature review on features and effects.Medical journal of the Islamic Republic of Iran · 2021Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors.
Funding
Abstract
backgroundSome drugs have a narrow therapeutic range and require monitoring and dose adjustments to optimize their efficacy and safety. Computerized clinical decision support systems (CCDSSs) may improve the net benefit of these drugs. The objective of this review was to determine if CCDSSs improve processes of care or patient outcomes for therapeutic drug monitoring and dosing.
methodsWe conducted a decision-maker-researcher partnership systematic review. Studies from our previous review were included, and new studies were sought until January 2010 in MEDLINE, EMBASE, Evidence-Based Medicine Reviews, and Inspec databases. Randomized controlled trials assessing the effect of a CCDSS on process of care or patient outcomes were selected by pairs of independent reviewers. A study was considered to have a positive effect (i.e., CCDSS showed improvement) if at least 50% of the relevant study outcomes were statistically significantly positive.
resultsThirty-three randomized controlled trials were identified, assessing the effect of a CCDSS on management of vitamin K antagonists (14), insulin (6), theophylline/aminophylline (4), aminoglycosides (3), digoxin (2), lidocaine (1), or as part of a multifaceted approach (3). Cluster randomization was rarely used (18%) and CCDSSs were usually stand-alone systems (76%) primarily used by physicians (85%). Overall, 18 of 30 studies (60%) showed an improvement in the process of care and 4 of 19 (21%) an improvement in patient outcomes. All evaluable studies assessing insulin dosing for glycaemic control showed an improvement. In meta-analysis, CCDSSs for vitamin K antagonist dosing significantly improved time in therapeutic range.
conclusionsCCDSSs have potential for improving process of care for therapeutic drug monitoring and dosing, specifically insulin and vitamin K antagonist dosing. However, studies were small and generally of modest quality, and effects on patient outcomes were uncertain, with no convincing benefit in the largest studies. At present, no firm recommendation for specific systems can be given. More potent CCDSSs need to be developed and should be evaluated by independent researchers using cluster randomization and primarily assess patient outcomes related to drug efficacy and safety.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.