Review of computerized clinical decision support in community pharmacy

What is known and objective: Clinical decision support software (CDSS) has been increasingly implemented to assist improved prescribing practice. Reviews and studies report generally positive results regarding prescribing changes and, to a lesser extent, patient outcomes. Little information is available, however, concerning the use of CDSS in community pharmacy practice. Given the apparent paucity of publications examining this topic, we conducted a review to determine whether CDSS in community pharmacy practice can improve medication use and patient outcomes.

Methods: A literature search of articles on CDSS relevant to community pharmacy and published between 1 January 2005 and 21 October 2013 was undertaken. Articles were included if the healthcare setting was community pharmacy and the article indicated that pharmacy use of CDSS was part of the study intervention.

Results and discussion: Eight studies were found which assessed counselling, selected drug interactions, inappropriate prescribing and under-prescribing. One study was halted due to insufficient data collection. Six studies showed statistically significant improvements in the measured outcomes: increased patient counselling, 31% reduced frequency of drug-drug interactions (DDIs), reduced frequency of inappropriate medications in the elderly (2·2-1·8% patients) and in pregnant women (5·5-2·9% patients), and increased pharmacists' interventions for under-prescribed low-dose aspirin (1·74 vs. 0·91 per 100 patients with type 2 diabetes) and over-prescribed high-dose proton-pump inhibitors (PPIs) (1·67 vs. 0·17 interventions per 100 high-dose PPI prescriptions).

What is new and conclusion: Most studies showed improved prescribing practice, via direct communication between pharmacists and doctors or indirectly via patient education. Factors limiting the impact of improved prescribing included alert fatigue and clinical inertia. No study investigated patient outcomes and little investigation had been undertaken on how CDSS could be best implemented. Few studies have been undertaken in community pharmacy practice, and based on the positive findings reported, further research should be directed in this area, including investigation of patient outcomes.