The evaluation of the reviewed studies provided us with enlightening information with respect to the aims of the research, types of electronic prescribing systems, illness types and patients. The findings also showed that in several diseases such as cardiovascular disease, high blood pressure and diabetes, or cases such as simultaneous prescription of drugs, the effect of CDSS was evaluated. Findings from the analyzed studies are presented in the following tables in which * stands for p values and indicates a statistically significant difference.
Also, the results of the quest are shown in Figure 1.
The number of studies based on multiple evaluation results and types of studies are shown respectively in Figures 2 and 3.
The effect of CDSS on cardiovascular diseases
For patients admitted to hospital, the level of venous thromboembolism prophylaxis and the proportion of prescribed prophylaxis increased from six to 24 hours after admission for clinicians allocated to venous thromboembolism reminder CDSS . In another study, differences among physicians over the thromboprophylaxis treatment effect decreased with the help of CDSS providing treatment recommendation (p-value=0.02) . In other studies, alert based CDSSs have been effective in physician behavior and progressive treatment improvement in anti-inflammatory drugs and lipid-lowering drugs, which has also been statistically significant [14-16]. As stated in another study, by following medical recommendations, doctors in the intervention group were able to improve the prescribing level of secondary preventive medication with the help of a regular CDSS .
In the other trials, the short message of the program in patient outcomes had a positive effect on patient adherence to medication, diet, and cardiovascular disease (p-value<0.01) [18, 19]. Table 1 shows the result briefly.
The effect of CDSS on hypertension
For one study, the electronic monitoring and recall program had no effect on blood pressure reduction and the admission of patients . However, in the other study, the patient outcome improved after the implementation of the CDSS . Table 2 shows the result briefly.
The effect of CDSS on diabetes
In some studies, the Real Time Medication Monitoring (RTMM) system, equipped with a short message reminder, improved precision of patients’ compliance and taking forgotten dosages [23-26]. In another study, HbA1c and group differences were greater in the intervention group using recommendation CDSS than in the control group . The use of statins (p-value=0.03) and the problem areas in diabetes (PAID) (p-value=0.01) improved in another study for intervention group using CDSS . Table 3 shows the result briefly.
The effect of CDSS on digestive diseases
In all studies, the CDSS had an effect on prescribing non-steroidal anti-inflammatory drugs, proton pump inhibitors, and increasing the standard use of oral rehydration solution without any difference in other results [28-30]. The alert based CDSS was able to improve the quality of patient care to some degree in the other study . Table 4 shows the result briefly.
The effect of CDSS on pulmonary diseases
In some trials, the use of CDSS integrated with electronic health record, learning or prediction rules resulted in a decrease in the prescribing of antibiotics and macrolides, thereby minimizing inappropriate use of antibiotics (p-value=0.0005), decreasing resistance to antibiotics (p-value=0.04), and enhancing primary care [31-35]. The patients had adhered to the reminder message of using their medication in another study; however, the messages did not affect therapy success . Table 5 shows the result briefly.
The effect of CDSS on AIDS
In the study, it was shown that the reminder systems for short text messages had a positive effect on the treatment process for antivirus. The length of the messages also required more attention from the physicians, but had no significant effect on patient compliance rates (p-value=0.12) . Table 6 shows the result briefly.
The Effect of CDSS on appendicitis
The study showed that the system's systematically developed order set using clinical guidelines increased system usability (p value=0.05) and reduced system-related problems related to unfamiliarity with the system (p-value=0.05). This method resulted in the Computerized Provider Order Entry (CPOE) improving efficiency, quality and safety . Table 7 shows the result briefly.
The effect of CDSS on kidney diseases
One study showed the positive effect of multipurpose intervention on creatinine value estimation and dose adjustment to reduce the insufficient dosage of primary care drugs . In the other study, the appropriate prescription rate for kidney problems was rather low, contrary to the results of the study by the former. Furthermore, the effectiveness of the CDSS equipped with physician guidelines has been increased, especially for new versions . Table 8 shows the result briefly.
The effect of CDSS on taking multiple medications
In one study, 194 hard-alerted CDSSs resulted in delayed drug treatment for four patients requiring immediate treatment, suggesting that adverse events of these systems need to be evaluated and monitored . In another study, the CDSS improved the primary dose of medication, time intervals for drug use, and drug concentration, which is to be injected intravenously compared to standard doses . Also In another study, the average number of readmission days for each patient and the combination of re-hospitalization and emergency ward visits in the 30 days after hospital discharge was not different in the intervention group using Recommendation CDSS with control groups . In some trials, there was no discrepancy between the outcomes of the dosage rate and the Modified Medication Appropriateness Index (MMAI), improper medication prescribing (p-value=0.48), the Medication Regimen Complexity Index and the mean pain outcome difference after 6 months (p-value=0.13) and 9 months (p-value=0.78) between intervention group using alert or reminder CDSS with control group [44, 45]. Table 9 shows the result briefly.
The effect of CDSS on Malaria
The use of text messages in the study did not affect the behavior of patients in completing the course of medication for the full duration of treatment. However, if the side effects were low (p-value=0.02), it had effects in continuing to use the medication. In addition, text messages had an effect on the physicians’ knowledge in using medication with fatty foods (p-value<0.0001) . Table 10 shows the result briefly.
The effect of CDSS on increasing blood potassium
In one study, in following alerts and patient compliance rate, there is no statistical difference between control and intervention groups. The doctors’ compliance rate improved at the medium potassium level from 3 to 3.9 (mili-equivalents/liter) (p-value<0.01) . Due to the rapid response of the physicians to program reminders and alerts for high potassium levels in the intervention group, the positive effect of the system on physician behavior was evident in another study (p-value=0.01) and a high level of potassium (p-value=0.05). Thus, patient safety could be increased . In another study, the time lapse in hyperkalemia monitoring (p-value=0.20) and the incidence rate of hyperkalemia (p-value=0.22) did not differ significantly even with use of three different kind of reminder and alert based CDSSs . Table 11 shows the result briefly.
The effect of CDSS on medication prescription for patients
Based on the results of some studies, the regular or alert based CDSSs resulted in better drug prescriptions for the proton pump inhibitor and a reduction in abbreviation prescriptions [4, 50]. In the other studies, the overall utilization of system functionalities, system utilization between two time laps (p-value<0.0001), number of users (p-value<0.0001) and physician compliance regarding drug recommendations given by the CDSS improved drug prescriptions, which eventually resulted in reduced side effects (p-value=0.02) and harm to patients due to the lower number of errors regarding the alert based CDSS [5, 51]. There was no difference in drug prescription between physicians in one study (p-value=0.14); However, the percentage of skill questions answered for the intervention group equipped with training CDSS (p-value=0.01) improved . In another study, alert based CDSSs have been effective in identifying evidence-based pharmacotherapies (EBP) and the compliance with treatment by health care managers and have had no effect on the outcome of patients . Table 12 shows the result briefly.
The effect of CDSS on mental disorders
DSS alerts resulted in reduced risk of injury and reduced dose of antipsychotics and anticoagulants (p-value=0.03) from the start of the study up to a year. Therefore, the CDSS reduced the risk of injury (p-value=0.02) . Table 13 shows the result briefly.