Large-scale, community-based trial of a personalized drug-related problem rectification system

Objectives: The risk of clinically significant drug-related problems is a major concern, particularly among elderly, polypharmacy-treated patients. Previous efforts to develop computerized alert systems have shown limited effectiveness. The purpose of this study was to evaluate the efficacy of a novel technology, the Drug-Drug Interaction Plus (DDI+) decision support system, used in a real-world ambulatory health maintenance organization (HMO) setting and developed to overcome the limitations of currently available programs. Study Design: Controlled trial. Methods: We conducted a controlled trial of the DDI+ system in Leumit Health Services (LHS), an HMO in Israel that provides coverage to approximately 700,000 members with approximately 2000 physicians nationally. All LHS physicians were geographically allocated by region to a study or control arm. Physician access rates, alert resolution rates, and resource utilization of their patients were evaluated and compared between the intervention and control arms. Results: There were 5.6% (P =.001) fewer mean episodes of hospitalization, 1.5% (P =.01) fewer mean drugs dispensed, and 2.1% (P =.055) fewer mean episodes of imaging in the intervention population versus controls. Drug-related problems that were re-encountered were often rectified without re-accessing the system. Conclusions: Comparing the acceptance by physicians of the DDI+ system to reports of acceptance of similar systems, DDI+ was observed to be better accepted. This will possibly initiate improvements in resource utilization patterns. We surmise that improved physician willingness to access the system can be attributed to the novel graphic presentation, specificity, and integration of DDI+ into the work flow of routine clinical practice.