PMID- 37155711
OWN - NLM
STAT- MEDLINE
DCOM- 20230731
LR  - 20230731
IS  - 1535-2900 (Electronic)
IS  - 1079-2082 (Linking)
VI  - 80
IP  - 15
DP  - 2023 Jul 21
TI  - Impact of transitioning to an active, noninterruptive CYP2C19/proton pump 
      inhibitor alert on prescribing patterns.
PG  - 1004-1009
LID - 10.1093/ajhp/zxad100 [doi]
AB  - PURPOSE: To compare rates of prescriber acceptance of interruptive and 
      noninterruptive clinical decision support (CDS) alerts regarding potential 
      diminished therapeutic effectiveness and safety risks associated with proton pump 
      inhibitor (PPI) use in carriers of gene variants affecting cytochrome P450 (CYP) 
      isozyme 2C19 metabolism. METHODS: A retrospective study was conducted at a large 
      rural health system to examine different approaches to improving CDS alert 
      acceptance while minimizing alert fatigue. Manual reviews were conducted to 
      identify alerts regarding CYP2C19 metabolizer status displayed at the time of PPI 
      ordering over 30-day periods before and after the transition from interruptive to 
      noninterruptive CDS alert functionality. A chi-square test was conducted to 
      analyze prescriber acceptance of CDS recommendations by alert modality and type 
      of treatment modification. RESULTS: Overall, interruptive alerts had an 
      acceptance rate of 18.6% (64/344), compared to 8.4% acceptance (30/357 alerts) 
      for noninterruptive alerts (P </= 0.0001). Analysis of acceptance criteria 
      -revealed the noninterruptive alert cohort had higher acceptance, as determined 
      by documented medication dose adjustments, than the interruptive alert cohort 
      (53.3% [16/30] and 4.7% [3/64], respectively). The difference in acceptance rates 
      by CDS modality and treatment modification was statistically significant (P </= 
      0.00001). The predominant indication for PPI use was gastroesophageal reflux 
      disease (GERD) in both cohorts. CONCLUSION: Interruptive alerts that actively 
      influenced workflow had higher acceptance rates than noninterruptive alerts that 
      served an informational purpose without a direct disruption of workflow. The 
      study results suggest the utilization of noninterruptive alerts may be a 
      beneficial tool for prompting clinicians to alter dosing regimens rather than 
      transition to an alternative agent.
CI  - (c) American Society of Health-System Pharmacists 2023. All rights reserved. For 
      permissions, please e-mail: journals.permissions@oup.com.
FAU - Massmann, Amanda
AU  - Massmann A
AUID- ORCID: 0000-0002-5401-5318
AD  - Sanford Imagenetics, Sanford Health, Sioux Falls, SD.
AD  - Sanford School of Medicine, University of South Dakota, Vermillion, SD, USA.
FAU - Petry, Natasha J
AU  - Petry NJ
AUID- ORCID: 0000-0001-5089-9286
AD  - Sanford Imagenetics, Sanford Health, Sioux Falls, SD.
AD  - Department of Pharmacy Practice, North Dakota State University, Fargo, ND, USA.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Am J Health Syst Pharm
JT  - American journal of health-system pharmacy : AJHP : official journal of the 
      American Society of Health-System Pharmacists
JID - 9503023
RN  - EC 1.14.14.1 (CYP2C19 protein, human)
RN  - EC 1.14.14.1 (Cytochrome P-450 CYP2C19)
RN  - 0 (Proton Pump Inhibitors)
SB  - IM
MH  - Humans
MH  - Cytochrome P-450 CYP2C19/chemistry/drug effects
MH  - *Decision Support Systems, Clinical
MH  - *Medical Order Entry Systems
MH  - Medication Errors
MH  - Proton Pump Inhibitors
MH  - Retrospective Studies
OTO - NOTNLM
OT  - CYP2C19
OT  - clinical decision support
OT  - decision-making
OT  - pharmacogenetics
OT  - pharmacogenomics
OT  - proton pump inhibitors
EDAT- 2023/05/08 18:42
MHDA- 2023/07/24 06:42
CRDT- 2023/05/08 14:43
PHST- 2023/07/24 06:42 [medline]
PHST- 2023/05/08 18:42 [pubmed]
PHST- 2023/05/08 14:43 [entrez]
AID - 7157015 [pii]
AID - 10.1093/ajhp/zxad100 [doi]
PST - ppublish
SO  - Am J Health Syst Pharm. 2023 Jul 21;80(15):1004-1009. doi: 10.1093/ajhp/zxad100.