Clinical validation of clinical decision support systems for medication review: A scoping review

• Published in: British journal of clinical pharmacology Vol. 88; no. 5; pp. 2035 - 2051
• Main Authors: Damoiseaux‐Volman, Birgit A., Medlock, Stephanie, Meulen, Delanie M., Boer, Jesse, Romijn, Johannes A., Velde, Nathalie, Abu‐Hanna, Ameen
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.05.2022
• Subjects: adverse drug events; clinical decision support systems; Decision Support Systems, Clinical; Drug-Related Side Effects and Adverse Reactions - prevention & control; Humans; inappropriate prescriptions; Medication Review; Outcome Assessment, Health Care; Potentially Inappropriate Medication List; Review; validation studies; adverse drug events; inappropriate prescriptions; validation studies; clinical decision support systems
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.15160

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.