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Computerized advice on drug dosage to improve prescribing practice
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Gillaizeau, F., Chan, E., Trinquart, L., Colombet, I., Walton, Robert, Rège-Walther, M., Burnand, B. and Durieux, P. (2013) Computerized advice on drug dosage to improve prescribing practice. The Cochrane database of systematic reviews, 11 . CD002894. doi:doi: 10.1002/14651858.CD002894.pub3 ISSN 1469-493X.
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Official URL: http://dx.doi.org/10.1002/14651858.CD002894.pub3
Abstract
Background
Physicians and other healthcare professionals often prescribe drugs that will only work at certain concentrations. These drugs are said to have a narrow therapeutic window. This means that if the concentration of the drug is too high or too low, they may cause serious side effects or not provide the benefits they should. For example, blood thinners (anticoagulants) are prescribed to thin the blood to prevent clots. If the concentration is too high, people may experience excessive bleeding and even death. In contrast, if the concentration is too low, a clot could form and cause a stroke. For these types of drugs, it is important that the correct amount of the drug be prescribed. Calculating and prescribing the correct amount can be complicated and time-consuming for healthcare professionals. Sometimes determining the correct dose can take a long time since healthcare professionals may not want to prescribe high doses of the drugs initially because they make mistakes in calculations. Several computer systems have been designed to do these calculations and assist healthcare professionals in prescribing these types of drugs.
Study characteristics
We sought clinical trial evidence from scientific databases to evaluate the effectiveness of these computer systems. The evidence is current to January 2012. We found data from 42 trials (40 randomized controlled trials (trials that allocate people at random to receive one of a number of drugs or procedures) and two non-randomized controlled trials).
Key results
Computerized advice for drug dosage can benefit people taking certain drugs compared with empiric dosing (where a dose is chosen based on a doctor’s observations and experience) without computer assistance. When using the computer system, healthcare professionals prescribed appropriately higher doses of the drugs initially for aminoglycoside antibiotics and the correct drug dose was reached more quickly for oral anticoagulants. It significantly decreased thromboembolism (blood clotting) events for anticoagulants and tended to reduce unwanted effects for aminoglycoside antibiotics and anti-rejection drugs (although not an important difference). It tended to reduce the length of hospital stay compared with routine care with comparable or better cost-effectiveness. There was no evidence of effects on death or clinical side events for insulin (low blood sugar (hypoglycaemia)), anaesthetic agents, anti-rejection drugs (drugs taken to prevent rejection of a transplanted organ) and antidepressants.
Quality of evidence
The quality of the studies was low so these results must be interpreted with caution.
Item Type: | Journal Article | ||||||
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Subjects: | R Medicine > RM Therapeutics. Pharmacology | ||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Drugs -- Dosage -- Computer programs, Drugs -- Prescribing, Pharmaceutical arithmetic | ||||||
Journal or Publication Title: | The Cochrane database of systematic reviews | ||||||
Publisher: | Wiley Blackwell | ||||||
ISSN: | 1469-493X | ||||||
Official Date: | 11 November 2013 | ||||||
Dates: |
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Volume: | 11 | ||||||
Number of Pages: | 173 | ||||||
Article Number: | CD002894 | ||||||
DOI: | doi: 10.1002/14651858.CD002894.pub3 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Reuse Statement (publisher, data, author rights): | cited By 31 | ||||||
Access rights to Published version: | Restricted or Subscription Access | ||||||
Date of first compliant deposit: | 14 November 2017 | ||||||
Date of first compliant Open Access: | 15 November 2017 | ||||||
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