title: Development, validation and evaluation of an electronic pharmacological tool: The Drug Burden Index Calculator©.
abstract: The Drug Burden Index (DBI) is a pharmacological risk assessment tool that measures the total exposure to anticholinergic and sedative medicines, which may impair function in older adults. A computerized clinical decision support system (CCDSS) for DBI has not been previously developed or evaluated.
  
  
  
  (a) Develop a CCDSS that calculates and generates reports on DBI; (b) validate the CCDSS for accuracy; and (c) evaluate the CCDSS for use in clinical practice.
  
  
  
  The DBI Calculator© application, based on the published formula and Australian registered prescribing information was built and designed using Microsoft Access 2010. Accuracy testing involved the comparison of DBI scores computed manually (gold standard) with those computed using The DBI Calculator© for 25 published medication review case studies. Agreement was measured using Cohen's Kappa statistic. To evaluate the CCDSS application in practice, ten pharmacists completed a performance test and usability survey. Participants were timed performing a DBI calculation with the application for a fictitious patient case. The interface, functionality, clinical applications and user satisfaction of the application were rated using 5-point, Likert-type scales.
  
  
  
  Excellent agreement between the manual and CCDSS application was observed (Cohen's Kappa 0.95). In the evaluation phase, the average time (mins:sec ± SD) for participants to complete the task was 7:20 ± 1:45 and the DBI Calculator© was considered useful by 80% of pharmacists for recognizing sedative and anticholinergic medicines in practice.
  
  
  
  A reliable CCDSS has been developed to report DBI of older patients taking multiple medications. Future studies should test the utility of The DBI Calculator© in clinical practice.
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia; Sydney Medical School - Northern, University of Sydney, New South Wales 2006, Australia. Electronic address: lisa.kouladjian@sydney.edu.au.
authors.forename: Lisa
authors.initials: L
authors.lastname: Kouladjian
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia; Sydney Medical School - Northern, University of Sydney, New South Wales 2006, Australia; Faculty of Pharmacy, University of Sydney, New South Wales 2006, Australia.
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.affiliation: Faculty of Pharmacy, University of Sydney, New South Wales 2006, Australia.
authors.forename: Timothy F
authors.initials: TF
authors.lastname: Chen
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, Kolling Institute of Medical Research, Northern Sydney Local Health District, St Leonards, New South Wales 2065, Australia; Sydney Medical School - Northern, University of Sydney, New South Wales 2006, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000328:Adult; D001315:Australia; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000009:adverse effects*; D016303:Clinical Pharmacy Information Systems; D020000:Decision Support Systems, Clinical; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects*; D008297:Male; D010593:Pharmaceutical Services / Q000458:organization & administration; D010595:Pharmacists / Q000458:organization & administration; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D013647:Task Performance and Analysis; D013997:Time Factors
chemical_list: D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives
keywords: Computerized decision support system; Drug burden index; Usability