A Cochrane review [Abstract] 1 included 42 studies (26 comparisons), including a wide range of drugs in inpatient and outpatient settings. Most of the studies provided advice about appropriate drug dosages to health care professionals who then decided whether to follow this or not. Interventions usually targeted doctors although some studies attempted to influence prescriptions by pharmacists and nurses. Most of the computer support systems used a mathematical model of the pharmacokinetics of the drug to predict the required dose.
Computerized advice for drug dosage gave significant benefits by: 1)leading to a physiological parameter more often within the desired range for oral anticoagulants (SMD for percentage of time spent in target international normalized ratio +0.19, 95% CI 0.06 to 0.33) and insulin (SMD for percentage of time in target glucose range: +1.27, 95% CI 0.56 to 1.98); 2) increasing serum concentrations (standardised mean difference0.79, 95% CI 0.46 to 1.13) and the proportion of people with plasma drug concentrations within the therapeutic range after two days (pooled risk ratio (RR) 4.44, 95% CI 1.94 to 10.13) for aminoglycoside antibiotics; 3)decreaseasing the time to achieve stabilization for oral anticoagulants (SMD -0.56, 95% CI -1.07 to -0.04; 4) decreaseasing the thromboembolism events (rate ratio 0.68, 95% CI 0.49 to 0.94) and tending to decrease bleeding events for anticoagulants although the difference was not significant (rate ratio 0.81, 95% CI 0.60 to 1.08). It tended to decrease unwanted effects for aminoglycoside antibiotics (nephrotoxicity: RR 0.67, 95% CI 0.42 to 1.06) and anti-rejection drugs (cytomegalovirus infections: RR 0.90, 95% CI 0.58 to 1.40); 5) tending to reduce the length of time spent in the hospital although the difference was not significant (SMD -0.15, 95% CI -0.33 to 0.02) and to achieve comparable or better cost-effectiveness ratios than usual care. There was no evidence of differences in mortality or other clinical adverse events for insulin (hypoglycaemia), anaesthetic agents, anti-rejection drugs and antidepressants.
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