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TY - JOUR

T1 - Clinical validation of clinical decision support systems for medication review

T2 - A scoping review

AU - Damoiseaux-Volman, Birgit A.

AU - Medlock, Stephanie

AU - van der Meulen, Delanie M.

AU - de Boer, Jesse

AU - Romijn, Johannes A.

AU - van der Velde, Nathalie

AU - Abu-Hanna, Ameen

N1 - Funding Information: The innovation funds of Amsterdam UMC, location AMC, supported this work. The sponsor had no role in the design, methods, data collection, analysis and preparation of this paper. Publisher Copyright: © 2021 The Authors. British Journal of Clinical Pharmacology published by John Wiley & Sons Ltd on behalf of British Pharmacological Society.

PY - 2022/5

Y1 - 2022/5

N2 - The aim of this scoping review is to summarize approaches and outcomes of clinical validation studies of clinical decision support systems (CDSSs) to support (part of) a medication review. A literature search was conducted in Embase and Medline. In total, 30 articles validating a CDSS were ultimately included. Most of the studies focused on detection of adverse drug events, potentially inappropriate medications and drug-related problems. We categorized the included articles in three groups: studies subjectively reviewing the clinical relevance of CDSS's output (21/30 studies) resulting in a positive predictive value (PPV) for clinical relevance of 4–80%; studies determining the relationship between alerts and actual events (10/30 studies) resulting in a PPV for actual events of 5–80%; and studies comparing output of CDSSs to chart/medication reviews in the whole study population (10/30 studies) resulting in a sensitivity of 28–85% and specificity of 42–75%. We found heterogeneity in the methods used and in the outcome measures. The validation studies did not report the use of a published CDSS validation strategy. To improve the effectiveness and uptake of CDSSs supporting a medication review, future research would benefit from a more systematic and comprehensive validation strategy.

AB - The aim of this scoping review is to summarize approaches and outcomes of clinical validation studies of clinical decision support systems (CDSSs) to support (part of) a medication review. A literature search was conducted in Embase and Medline. In total, 30 articles validating a CDSS were ultimately included. Most of the studies focused on detection of adverse drug events, potentially inappropriate medications and drug-related problems. We categorized the included articles in three groups: studies subjectively reviewing the clinical relevance of CDSS's output (21/30 studies) resulting in a positive predictive value (PPV) for clinical relevance of 4–80%; studies determining the relationship between alerts and actual events (10/30 studies) resulting in a PPV for actual events of 5–80%; and studies comparing output of CDSSs to chart/medication reviews in the whole study population (10/30 studies) resulting in a sensitivity of 28–85% and specificity of 42–75%. We found heterogeneity in the methods used and in the outcome measures. The validation studies did not report the use of a published CDSS validation strategy. To improve the effectiveness and uptake of CDSSs supporting a medication review, future research would benefit from a more systematic and comprehensive validation strategy.

KW - adverse drug events

KW - clinical decision support systems

KW - inappropriate prescriptions

KW - validation studies

UR - http://www.scopus.com/inward/record.url?scp=85121371303&partnerID=8YFLogxK

U2 - 10.1111/bcp.15160

DO - 10.1111/bcp.15160

M3 - Review article

C2 - 34837238

VL - 88

SP - 2035

EP - 2051

JO - British journal of clinical pharmacology

JF - British journal of clinical pharmacology

SN - 0306-5251

IS - 5

ER -