Computerized Decision Support Improves Medication Review Effectiveness: An Experiment Evaluating the STRIP Assistant's Usability

Abstract

BACKGROUND: Polypharmacy poses threats to patients' health. The Systematic Tool to Reduce Inappropriate Prescribing (STRIP) is a drug optimization process for conducting medication reviews in primary care. To effectively and efficiently incorporate this method into daily practice, the STRIP Assistant--a decision support system that aims to assist physicians with the pharmacotherapeutic analysis of patients' medical records--has been developed. It generates context-specific advice based on clinical guidelines. OBJECTIVE: The aim of this study was to validate the STRIP Assistant's usability as a tool for physicians to optimize medical records for polypharmacy patients. METHODS: In an online experiment, 42 physicians were asked to optimize medical records for two comparable polypharmacy patients, one in their usual manner and one using the STRIP Assistant. Changes in effectiveness were measured by comparing respondents' optimized medicine prescriptions with medication prepared by an expert panel of two geriatrician-pharmacologists. Efficiency was operationalized by recording the time the respondents took to optimize the two cases. User satisfaction was measured with the System Usability Scale (SUS). Independent and paired t tests were used for analysis. RESULTS: Medication optimization significantly improved with the STRIP Assistant. Appropriate decisions increased from 58% without the STRIP Assistant to 76% with it (p < 0.0001). Inappropriate decisions decreased from 42% without the STRIP Assistant to 24% with it (p < 0.0001). Participants spent significantly more time optimizing medication with the STRIP Assistant (24 min) than without it (13 min; p < 0.0001). They assigned it a below-average SUS score of 63.25. CONCLUSION: The STRIP Assistant improves the effectiveness of medication reviews for polypharmacy patients.