title: Nature and frequency of drug therapy alerts generated by clinical decision support in community pharmacy.
abstract: OBJECTIVE
  The purpose of this study is to investigate the nature, frequency, and determinants of drug therapy alerts generated by a clinical decision support system (CDSS) in community pharmacy in order to propose CDSS improvement strategies.
  
  
  METHODS
  This is a retrospective analysis of dispensed drugs and drug therapy alerts generated by a CDSS in community pharmacies.
  
  
  RESULTS
  Data were extracted from the CDSS of 123 community pharmacies. After taking a 10% random sample of patients with a prescription in the period August 2013-July 2014, 1,672,169 dispensed prescriptions from 81,742 patients were included in the analysis. Of all processed prescriptions, 43% led to one or more drug safety alerts, most frequently drug-drug interaction alerts (15% of all prescriptions), drug-disease interaction alerts (14%), duplicate medication alerts (13%), and dosing alerts (7%). The majority of prescriptions with alerts (80%) were clustered in a minority of patients (16%). The therapeutic drug group of the prescribed drug was the most important determinant of alert generation. Prescriptions for antithrombotic agents accounted for 9.4% of all prescriptions with an alert, beta-blocking agents for 7.5% and angiotensin-converting-enzyme inhibitors for 6.1%.
  
  
  CONCLUSIONS
  The investigated CDSS in Dutch community pharmacy generated one or more drug therapy alerts in nearly half of the processed prescriptions. The majority of alerts were concentrated in a minority of therapeutic drug groups and patients. To decrease the alert burden, CDSS improvements should be directed at the prioritization and integration of drug therapy alerts for these therapeutic groups within patients.
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.|Health Base Foundation, Houten, The Netherlands.
authors.forename: Mette
authors.identifier: http://orcid.org/0000-0001-8316-8148
authors.initials: M
authors.lastname: Heringa
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Annemieke
authors.initials: A
authors.lastname: Floor-Schreudering
authors.affiliation: Health Base Foundation, Houten, The Netherlands.
authors.forename: P Chris
authors.initials: PC
authors.lastname: Tromp
authors.affiliation: Departments of Clinical Pharmacy and IQ Healthcare, University Medical Centre St Radboud, Nijmegen, The Netherlands.
authors.forename: Peter A G M
authors.initials: PA
authors.lastname: de Smet
authors.affiliation: SIR Institute for Pharmacy Practice and Policy, Leiden, The Netherlands.|Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
authors.forename: Marcel L
authors.initials: ML
authors.lastname: Bouvy
mesh_terms: D003157:Community Pharmacy Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D020000:Decision Support Systems, Clinical; D004347:Drug Interactions; D050316:Medical Order Entry Systems / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D008508:Medication Errors / Q000517:prevention & control / Q000706:statistics & numerical data; D009426:Netherlands; D012189:Retrospective Studies
keywords: clinical decision support systems; clinical risk management; community pharmacy; drug therapy alerts; pharmacoepidemiology; pharmacy information systems