title: Potential drug-related problems detected by electronic expert support system: physicians' views on clinical relevance.
abstract: BACKGROUND
  Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients' current prescriptions, including drug-drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients.
  
  
  OBJECTIVE
  The aim of the study was to explore physicians' views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs.
  
  
  METHODS
  Two geriatric clinics and three primary care units in Sweden.
  
  
  METHODS
  Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test.
  
  
  METHODS
  Physicians' perceived clinical relevance of each alert, and changes in drug treatment following the alerts.
  
  
  RESULTS
  Physicians perceived 68% (502/740) of EES alerts as clinically relevant and 11% of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert.
  
  
  CONCLUSIONS
  In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.
authors.affiliation: Department of Medicine and Optometry, eHealth Institute, Linnaeus University, 391 82, Kalmar, Sweden. tora.hammar@lnu.se.
authors.forename: Tora
authors.initials: T
authors.lastname: Hammar
authors.affiliation: Swedish eHealth Agency, Stockholm, Sweden.
authors.forename: Bodil
authors.initials: B
authors.lastname: Lidström
authors.affiliation: Department of Medicine and Optometry, eHealth Institute, Linnaeus University, 391 82, Kalmar, Sweden.
authors.forename: Göran
authors.initials: G
authors.lastname: Petersson
authors.affiliation: Division of Geriatric Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
authors.forename: Yngve
authors.initials: Y
authors.lastname: Gustafson
authors.affiliation: Swedish eHealth Agency, Stockholm, Sweden.|Division of Clinical Pharmacology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Birgit
authors.initials: B
authors.lastname: Eiermann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D050316:Medical Order Entry Systems; D008508:Medication Errors / Q000517:prevention & control*; D010820:Physicians / Q000523:psychology*
keywords: Alerts; Clinical decision support systems; Drug-related problems; Geriatric patients; Multi-dose drug dispensing; Relevance; Sweden