The Implementation of a Clinical Decision Support System for Managing Drug-Disease Interactions in Outpatients with Cardiovascular and Diabetic Comorbidities: An Interventional Study at a Tertiary Hospital in Vietnam

Abstract

Objectives:

To evaluate the effectiveness of a combined intervention consisting of a clinical decision support system (CDSS) integrated into the hospital information system (HIS) and pharmacist consultation in managing drug-disease interactions (DDSIs) among outpatients with cardiovascular disease (CVD) and diabetes mellitus (DM) comorbidities at a Tertiary Hospital in Vietnam.

Methods:

A pre- and post-interventional study was conducted using data from outpatient prescriptions and electronic medical records. The pre-intervention phase took place from May 1 to August 31, 2024, followed by the post-intervention phase from September 15, 2024, to January 15, 2025. Following the CDSS implementation in September 2024, clinical pharmacists performed interventions, which were prospectively documented. Descriptive statistics and comparative tests were used for data analysis.

Results:

Patient characteristics were comparable between two phases, with a mean age of 76 ± 8.5 years (pre-intervention phase) and 77 ± 7.5 years (post-intervention phase). After the intervention, the prevalence of absolute contraindication showed a statistically significant decrease (P < 0.05). The rate of relative contraindication plummeted from 0.33% to 0.01% (P < 0.05). Notably, relative contraindications involving bisoprolol – chronic obstructive pulmonary diseases and gliclazide-hepatic fibrosis – cirrhosis sharply reduced post-intervention (P < 0.001). “Use with caution” interactions also witnessed a decline from 0.20% to 0.13% (P < 0.05), most significantly for lisinopril/hydrochlorothiazide – gout (P < 0.001). Pharmacist interventions were largely fully accepted, except for a few gout-related cases that received partial acceptance. No interventions were rejected.

Conclusions:

The integration of CDSS into HIS and pharmacist interventions were associated with significantly reduced harmful DDSIs in high-risk CV-DM patients. This approach demonstrates the value of integrated clinical tools and multidisciplinary collaboration in optimizing medication safety in outpatient settings.