International Journal of Clinical Pharmacy

, Volume 37, Issue 5, pp 941–948 | Cite as

Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance

  • Tora HammarEmail author
  • Bodil Lidström
  • Göran Petersson
  • Yngve Gustafson
  • Birgit Eiermann
Research Article


Background Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients’ current prescriptions, including drug–drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients. Objective The aim of the study was to explore physicians’ views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs. Setting Two geriatric clinics and three primary care units in Sweden. Method Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test. Main outcome measure Physicians’ perceived clinical relevance of each alert, and changes in drug treatment following the alerts. Results Physicians perceived 68 % (502/740) of EES alerts as clinically relevant and 11 % of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert. Conclusion In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.


Alerts Clinical decision support systems Drug-related problems Geriatric patients Multi-dose drug dispensing Relevance Sweden 



The authors would like to express their gratitude to Abdul Aziz Ali for advice on statistical analyses. The authors would also like to thank Ramtin Atifeh and the participating health care units.


The study was financed by the eHealth Agency, the Medical Products Agency, and the Linnaeus University, Sweden.

Conflicts of interest



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Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2015

Authors and Affiliations

  • Tora Hammar
    • 1
    Email author
  • Bodil Lidström
    • 2
  • Göran Petersson
    • 1
  • Yngve Gustafson
    • 4
  • Birgit Eiermann
    • 2
    • 3
  1. 1.Department of Medicine and Optometry, eHealth InstituteLinnaeus UniversityKalmarSweden
  2. 2.Swedish eHealth AgencyStockholmSweden
  3. 3.Division of Clinical Pharmacology, Department of Laboratory MedicineKarolinska InstitutetStockholmSweden
  4. 4.Division of Geriatric Medicine, Department of Community Medicine and RehabilitationUmeå UniversityUmeåSweden

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