Effect of electronic drug-drug interaction alerts on patient and clinician outcomes: a systematic review

OBJECTIVES: Drug interaction checking software is ubiquitous in clinical decision support systems (CDSS-DI) but patient relevance and accuracy are variable and the impact on patient outcomes is unproven. We compared the effectiveness of CDSS-DI with similar care without CDSS-DI. MATERIALS AND METHODS: We searched multiple bibliographic databases from 1990 to end-2024 for randomized trials (RCTs) or prospective cohort studies evaluating CDSS-DI at prescription, dispensing, or administration compared to a control group, and assessing clinical, process and burden outcomes. We used Cochrane Risk of Bias v2.0 and ROBINS-I to assess risk of bias and random effects modeling using meta 6.0 package in R for meta-analysis. RESULTS: Eight studies were included-7 RCTs (2 parallel and 5 cluster) and 1 prospective cohort study (total N = 43 413 patients). Mortality rates were similar between intervention (0.14%) and control (0.07%) groups (OR: 1.94 [95% CI: 0.88-4.29], P = .078). One study reported a minor, possibly irrelevant, 3-hour decrease in length of stay (P = .0021) in the intervention group. CDSS-DI alerts modestly influenced prescribing behavior (OR: 2.08 [95% CI: 1.01-4.27], P = .05), but did not significantly reduce the incidence of targeted adverse drug interactions (OR: 0.86 [95% CI: 0.56-1.34], P = .37). DISCUSSION: Surprisingly little high-quality research addresses the effect of CDSS-DI on patient or clinician outcomes. Current evidence continues to suggest no major benefit for patient-important outcomes. Given the potential for harms and important time burdens, CDSS-DI alerting needs improvement. CONCLUSION: CDSS-DI alerts show no significant improvement in patient-important outcomes. Optimizing alert accuracy, clinical relevance, and patient-specific integration is essential to enhance their value in practice.