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A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting

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Abstract

Background

A six year collaboration between academics, community pharmacists and informaticians, led to the development of nine guidelines for a clinical decision support system, enhancing community pharmacists’ ability to address drug-related problems and improve care.

Aim

The objective of this study was to assess the effectiveness of clinical decision support system rules in enhancing medication management within the community pharmacy setting. This was achieved through retrospective monitoring of real-world usage and measuring the pharmacotherapeutic impact of the rules.

Method

In 2019, a retrospective observational evaluation appraised the acceptance rate of the clinical decision support system components in 490 Belgian pharmacies. Among these, 51 pharmacies underwent a longitudinal analysis involving (i) co-prescription of methotrexate and folic acid, (ii) gastroprotection with non-steroidal anti-inflammatory drugs, and (iii) drug combinations causing QT prolongation. The study period spanned one year pre-launch, one year post-launch, and two years post-launch.

Results

Of the targeted pharmacies, 80% used 7 of the 9 rules. After four years, methotrexate-folic acid co-prescription increased 4%, reaching 79.8%. Gastroprotection improved by 3% among older patients and 7.47% in younger individuals (< 70 year) with multiple risk factors. The QT prolongation rules faced implementation difficulties.

Conclusion

Pharmacists’ acceptance of the developed rules was high and coincided with a decline in drug-related problems, holding potential public health impact. This real-world data can inform the future implementation of such systems, as it demonstrated the need for more detailed data-gathering and more intensive training of pharmacists in the handling of more complex problems such as QT prolongation.

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Acknowledgements

The authors would like to thank Frederic Vancraeyveldt for the support in providing the analysis data and Bronwen Martin for her critical reading of the manuscript. Royal Society of Pharmacists of East Flanders (KOVAG) and University of Antwerp.

Funding

No specific funding was received.

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Author notes

  1. Nele Schoenmaekers, Marleen Haems, Michaël Storme and Hans De Loof have contributed equally to this work.

Authors and Affiliations

  1. Royal Society of Pharmacists of East Flanders (KOVAG), Brouwerijstraat 1, 9031, Ghent, Belgium

    Carolien Bogaerts, Nele Schoenmaekers, Marleen Haems & Michael Storme

  2. Laboratory of Physiopharmacology, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium

    Hans De Loof

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  1. Carolien Bogaerts
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Correspondence to Nele Schoenmaekers.

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Bogaerts, C., Schoenmaekers, N., Haems, M. et al. A quality improvement study of the implementation and initial results of a pragmatic clinical decision support system in the community pharmacy setting. Int J Clin Pharm 46, 141–149 (2024). https://doi.org/10.1007/s11096-023-01648-z

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