A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting.

backgroundA six year collaboration between academics, community pharmacists and informaticians, led to the development of nine guidelines for a clinical decision support system, enhancing community pharmacists' ability to address drug-related problems and improve care.

aimThe objective of this study was to assess the effectiveness of clinical decision support system rules in enhancing medication management within the community pharmacy setting. This was achieved through retrospective monitoring of real-world usage and measuring the pharmacotherapeutic impact of the rules.

methodIn 2019, a retrospective observational evaluation appraised the acceptance rate of the clinical decision support system components in 490 Belgian pharmacies. Among these, 51 pharmacies underwent a longitudinal analysis involving (i) co-prescription of methotrexate and folic acid, (ii) gastroprotection with non-steroidal anti-inflammatory drugs, and (iii) drug combinations causing QT prolongation. The study period spanned one year pre-launch, one year post-launch, and two years post-launch.

resultsOf the targeted pharmacies, 80% used 7 of the 9 rules. After four years, methotrexate-folic acid co-prescription increased 4%, reaching 79.8%. Gastroprotection improved by 3% among older patients and 7.47% in younger individuals (< 70 year) with multiple risk factors. The QT prolongation rules faced implementation difficulties.

conclusionPharmacists' acceptance of the developed rules was high and coincided with a decline in drug-related problems, holding potential public health impact. This real-world data can inform the future implementation of such systems, as it demonstrated the need for more detailed data-gathering and more intensive training of pharmacists in the handling of more complex problems such as QT prolongation.