Clinical Decision Support System(CDSS) 신기능 모듈 적용이신독성 약물 처방에 미치는 영향 분석

Abstract

It is clinically important to modify the dose of a nephrotoxic medication in the renal impairment patient for the appropriate therapeutic efficacy and prevention of an unnecessary adverse event. In our hospital, there is a recommended Clinical Decision Support System (CDSS) which works by recommending a dose modification as required, which is based on the patient’s Creatinine Clearance (CrCl). Its clinical impact was explored in this study. From January 1, 2012 to June 30, 2012, the prescription pattern changes were analyzed among the identified outpatient population who had received the first CDSS warning, but who were treated with the same medication in the previous 6 months in terms of prescription change rate and appropriate dose modification rate. Additionally, we analyzed which factor most impacted the doctor’s prescription behaviors from the following factors: patient age, severity of renal function, medication class, medication’s CrCl criteria required dose-adjustment, the difference between medication’s CrCl crite-ria required dose-adjustment and the patient’s CrCl. The total of 361 cases were analyzed in this study. The prescription change rate was 13.3% (48/361), and the noted appropriate dose modification rate was 77.8% (14/18). The multivariate logistic regression analysis showed that the nephrotoxic medication class and the difference between the medication’s CrCl criteria required dose-adjustment and the patient’s CrCl were the major determinants changed doctor’s prescription behaviors. Among the nephrotoxic medications class, it is noted that the antimicrobials were highly impacted on the prescription behavior referenced against anti-histamines (Odds ratio 4.46, 95% confidence interval 1.421 to 13.998, p = 0.0104). When the difference between the medication’s CrCl criteria required dose-adjustment and the patient’s CrCl became noted as larger than 20, as comparing with less (or equal) than 10, the doctors were apt to change their prescriptions more frequently (Odds ratio 5.013, 95% confidence interval 1.549 to 16.219, p=0.0071). In the future, in order to be more helpful to the patients and doctors through the distribution of CDSS information, it would be highly beneficial to have a system which can provide an appropriate dose and alert the clinicians according to the patient’s clinical situation, based on the patient’s renal function and medication dose appropriateness.