Digital clinical decision support to improve pharmacotherapy in hospitalized obese patients: A prospective intervention study

<h2>Abstract</h2><h3>Background</h3> In obese patients, standard medication dosing is often suboptimal and requires dose adjustments to body mass index (BMI) or body weight (BW). Digital clinical decision support (eCDS) may help optimize this. <h3>Objective</h3> This study aimed to assess the effect of eCDS on adjustments to BMI or BW in pharmacotherapy in hospitalized obese patients. <h3>Methods</h3> This prospective intervention study included hospitalized patients aged ≥ 18 years with a BMI of ≥ 30 kg/m² and/or BW ≥ 90 kg from January 1, 2022, to September 30, 2022 (before eCDS), and from October 10, 2022, to November 25, 2022 (after eCDS). After eCDS, pharmacy recommended dose adjustments to physicians based on eCDS, a tool that selected patients whose medication orders needed adjustment to BMI or BW. <h3>Outcome measures</h3> Study outcomes were prevalence of medication orders adjusted to BMI or BW before eCDS versus after eCDS; prevalence of post-eCDS patients with ≥ 1 medication order with a recommendation for adjustment; physician acceptance rate, including reasons for rejection; and occurrence of treatment failure/adverse events. <h3>Results</h3> In post-eCDS patients (n = 804), pharmacotherapy was significantly more often adjusted to BMI or BW than in pre-eCDS patients (n = 4428): 77.7% (912 of 1173 medication orders) after eCDS versus 58.2% (3519 of 6049 medication orders) before eCDS (<i>P</i> < 0.0001). After eCDS, 328 patients had ≥ 1 medication order, resulting in 349 pharmacotherapeutic recommendations. Physician acceptance rate was 53.3% (186 of 349 for 167 patients). Recommendations mainly concerned nadroparin (92.8% [324 of 349]) and antibiotics (6.9% [24 of 349]). The main reason for rejecting a recommendation was near discharge (90.8% [148 of 163]). No treatment failures and 4 possible adverse events occurred. <h3>Conclusions</h3> Implementation of eCDS significantly increased the prevalence of medication orders adjusted to BMI or BW in hospitalized obese patients and is useful in optimizing treatment for this growing population.