Work

Digital clinical decision support to improve pharmacotherapy in hospitalized obese patients: A prospective intervention study

Year: 2025

Type: article

Abstract: Background In obese patients, standard medication dosing is often suboptimal and requires dose adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimize this. Objective This study aimed to assess the effect of eCDS on adjustments to BMI or BW in pharmacotherapy in hospitalized obese patients. Methods This prospective intervention study included hospitalized patients aged ≥ 18 years with a BMI of ≥ 30 kg/m 2 and/or BW ≥ 90 kg from January 1, 2022, to September 30, 2022 (before eCDS), and from October 10, 2022, to November 25, 2022 (after eCDS). After eCDS, pharmacy recommended dose adjustments to physicians based on eCDS, a tool that selected patients whose medication orders needed adjustment to BMI or BW. Study outcomes were prevalence of medication orders adjusted to BMI or BW before eCDS versus after eCDS; prevalence of post-eCDS patients with ≥ 1 medication order with a recommendation for adjustment; physician acceptance rate, including reasons for rejection; and occurrence of treatment failure/adverse events. Results In post-eCDS patients (n = 804), pharmacotherapy was significantly more often adjusted to BMI or BW than in pre-eCDS patients (n = 4428): 77.7% (912 of 1173 medication orders) after eCDS versus 58.2% (3519 of 6049 medication orders) before eCDS ( P < 0.0001). After eCDS, 328 patients had ≥ 1 medication order, resulting in 349 pharmacotherapeutic recommendations. Physician acceptance rate was 53.3% (186 of 349 for 167 patients). Recommendations mainly concerned nadroparin (92.8% [324 of 349]) and antibiotics (6.9% [24 of 349]). The main reason for rejecting a recommendation was near discharge (90.8% [148 of 163]). No treatment failures and 4 possible adverse events occurred. Conclusions Implementation of eCDS significantly increased the prevalence of medication orders adjusted to BMI or BW in hospitalized obese patients and is useful in optimizing treatment for this growing population.

Source: JAPhA Practice Innovations

DOI: 10.1016/j.japhpi.2025.100077

Authors: Ala Keyany, Ilse Groenen, Sarb Saini, Barbara Maat

Institution: Elisabeth-TweeSteden Ziekenhuis

Language: English

Topic: Electronic Health Records Systems

Subfield: Health Information Management

Field: Health Professions

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $850