428 Computerised advice on drug dosage of some benefit

July 04, 2014

PEARLS 428, February 2014, written by Brian R McAvoy

Clinical question
How beneficial is computerised advice on drug dosage?

Bottom line
Compared with routine care, computerised advice on drug dosage increased the serum concentrations for aminoglycoside antibiotics, and improved the proportion of time for which the plasma drug was within the therapeutic range for aminoglycoside antibiotics and theophylline. It led to a physiological parameter more often within the desired range for oral anticoagulants and insulin. It decreased the time to achieve stabilisation for oral anticoagulants and reduced thromboembolism, reduced the length of hospital stay and tended to decrease unwanted effects of antirejection drugs and aminoglycoside antibiotics. It also significantly decreased unwanted effects for anticoagulants. In most trials, the computer-assisted dosage had lower or equivalent costs than manual dosage.

Caveat
The results are based on studies mainly of low quality, concerning a small number of drugs. The advice was system-initiated or user-initiated, and comprised a recommendation on specific drug dosage calculated by the computer. No conclusion could be drawn concerning the logistics of the computerised support and organisation of care aspects. It was not certain these benefits could be achieved with different computer systems in different clinical situations.

Context
Maintaining therapeutic concentrations of drugs with a narrow therapeutic window is a complex task. Several computer systems have been designed to help doctors determine optimum drug dosage. Significant improvements in healthcare could be achieved if computer advice improved health outcomes and could be implemented in routine practice in a cost-effective fashion.

Cochrane Systematic Review
Gillaizeau F et al. Computerised advice on drug dosage to improve prescribing practice. Cochrane Reviews, 2013, Issue 11. Art. No.: CD002894.DOI: 10.1002/14651858. CD002894.pub3. This review contains 42 studies with a median number of 779 participants.

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.