Improving ambulatory prescribing safety with a handheld decision support system: a randomized controlled trial.
OBJECTIVE
To evaluate the effectiveness of a personal digital assistant (PDA)-based clinical decision support system (CDSS) on nonsteroidal anti-inflammatory drug (NSAID) prescribing safety in the outpatient setting.


METHODS
The design was a randomized, controlled trial conducted in a university-based resident clinic. Internal medicine residents received a PDA-based CDSS suite. For intervention residents, the CDSS included a prediction rule for NSAID-related gastrointestinal risk assessment and treatment recommendations. Unannounced standardized patients (SPs) trained to portray musculoskeletal symptoms presented to study physicians. Safety outcomes were assessed from the prescriptions given to the SPs. Each prescription was reviewed by a committee of clinicians blinded to participant, intervention group assignment, and baseline or follow-up status.


METHODS
Prescriptions were judged as safe or unsafe. The main outcome measure was the differential change in unsafe prescribing of NSAIDs for the intervention versus the control group.


RESULTS
At baseline, the mean proportion of cases per physician with unsafe prescriptions for the two groups was similar (0.27 vs. 0.29, p > 0.05). Controlling for baseline performance, intervention participants prescribed more safely than controls after receiving the CDSS (0.23 vs. 0.45 [F = 4.24, p < 0.05]). With the CDSS, intervention participants documented more complete assessment of patient gastrointestinal risk from NSAIDs.


CONCLUSIONS
PARTICIPANTS provided with a PDA-based CDSS for NSAID prescribing made fewer unsafe treatment decisions than participants without the CDSS.
Berner
Eta S
ES
Department of Health Services Administration, University of Alabama at Birmingham, 1675 University Boulevard, Room 544, Birmingham, AL 35294-3361, USA. eberner@uab.edu
Houston
Thomas K
TK
Ray
Midge N
MN
Allison
Jeroan J
JJ
Heudebert
Gustavo R
GR
Chatham
W Winn
WW
Kennedy
John I
JI
Glandon
Gerald L
GL
Norton
Patricia A
PA
Crawford
Myra A
MA
Maisiak
Richard S
RS
D000555:Ambulatory Care Information Systems; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000627:therapeutic use*; D034201:Computers, Handheld; D020000:Decision Support Systems, Clinical; D004360:Drug Therapy, Computer-Assisted; D005767:Gastrointestinal Diseases / Q000139:chemically induced / Q000517:prevention & control; D006785:Hospitals, University; D006801:Humans; D008508:Medication Errors / Q000517:prevention & control; D010044:Outpatient Clinics, Hospital; D019095:Point-of-Care Systems; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal