Physicians' acceptance of drug-drug interaction alerts from clinical decision support systems: A systematic review and meta-analysis

Abstract

Background To reduce the risk of adverse drug events related to drug-drug interaction (DDI), healthcare systems worldwide are developing and implementing electronic health records with clinical decision support systems (CDSS). Primary studies have demonstrated that despite being useful, most of the alerts generated by these systems are ignored by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. Materials and methods The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. Quality assessment was performed by JBI critical appraisal tools, and the meta-analysis was performed using the R software. Results The overall prevalence of alert generated by CDSS was 13% (CI95% 5–24%, p-value < 0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85–95%, p-value < 0.0001, I^2 = 100%). Only 2 of the 16 studies showed moderate or low methodological quality. Discussion This systematic review presents data obtained from primary studies showing a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.