Digital clinical decision support to improve pharmacotherapy in (morbidly) obese patients: a prospective intervention study.

Abstract

Abstract Background In (morbidly) obese patients standard medication dosing is suboptimal and requires adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimise this. Aim To assess the effect of eCDS on adjustments to BMI/BW in pharmacotherapy in hospitalised (morbidly) obese patients. Method This prospective intervention study included hospitalised patients ≥18years with a BMI ≥30kg/m² and/or BW ≥90kg from 01.01.2022-30.09.2022 (pre-eCDS) and from 10.10.2022-25.11.2022 (post-eCDS). Post-eCDS, pharmacy recommended dose adjustments to physicians based on eCDS, a tool that selected patients whose medication order(s) needed adjustment to BMI/BW. Study outcomes were prevalence of medication orders adjusted to BMI/BW pre-eCDS versus post-eCDS, prevalence of post-eCDS patients with ≥1 medication order(s) 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/BW than in pre-eCDS patients (n=4,428): 77.7% (912/1,173 medication orders) post-eCDS versus 58.2% (3,519/6,049 medication orders) pre-eCDS (p<0.0001). Post-eCDS, 328 patients had ≥1 medication order(s) resulting in 349 pharmacotherapeutic recommendations. The acceptance rate by physicians was 53.3% (186/349 for 167 patients). The recommendations mainly concerned nadroparin [92.8% (324/349)] and antibiotics [6.9% (24/349)]. The main reason for rejecting a recommendation was near discharge [90.8% (148/163)]. No treatment failures and four possible adverse events occurred. Conclusion Implementation of eCDS significantly increased the prevalence of medication orders adjusted to BMI/BW in hospitalised (morbidly) obese patients and is useful to optimise treatment for this growing population.