Characteristics of the studies included in the analysis
| Characteristics analysed | Number of studies including the characteristic (%) | ||
| Total studies (n=42) | Studies with positive results (n=25) | Studies with negative or uncertain results (n=17) | |
| Setting | |||
| Hospital wards | 30 (71.4) | 19 (76.0) | 11 (64.7) |
| GP clinic | 5 (11.9) | 1 (4.0) | 4 (23.5) |
| Emergency department | 3 (7.1) | 1 (4.0) | 2 (11.8) |
| Clinical centre | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Community pharmacy | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Number of study sites | |||
| Monocentric | 26 (61.9) | 17 (68.0) | 9 (52.9) |
| Multicentric | 14 (33.3) | 6 (24.0) | 8 (47.1) |
| NA | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Clinical area | |||
| Hospitalised patients | 7 (16.7) | 4 (16.0) | 3 (17.6) |
| Paediatrics | 6 (14.3) | 4 (16.0) | 2 (11.8) |
| Infectious diseases | 5 (11.9) | 4 (16.0) | 1 (5.9) |
| Geriatrics | 5 (11.9) | 1 (4.0) | 4 (23.5) |
| Chronic non-hospitalised patients | 3 (7.1) | 3 (12.0) | 0 (0.0) |
| Respiratory diseases | 3 (7.1) | 2 (8.0) | 1 (5.9) |
| Nephrology | 3 (7.1) | 2 (8.0) | 1 (5.9) |
| Cardiology | 3 (7.1) | 1 (4.0) | 2 (11.8) |
| Diabetology | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Substance use disorder | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Oncology | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Haematology disorders | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Neurology | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| Purpose of application | |||
| Disease-related | |||
| Disease treatment and management | 16 (38.1) | 10 (40.0) | 6 (35.3) |
| Risk assessment of adverse outcomes | 3 (7.1) | 3 (12.0) | 0 (0.0) |
| Diagnosis | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Drug-related | |||
| Medication review | 12 (28.6) | 6 (24.0) | 6 (35.3) |
| Prescriptive appropriateness | 7 (16.7) | 4 (16.0) | 3 (17.6) |
| Deprescription | 3 (7.1) | 1 (4.0) | 2 (11.8) |
| Study design | |||
| RCT | 17 (40.5) | 5 (20.0) | 12 (70.6) |
| Pre-post intervention study | 13 (31.0) | 11 (44.0) | 2 (11.8) |
| Retrospective, observational study | 10 (23.8) | 7 (28.0) | 3 (17.6) |
| Non-controlled intervention study | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Quasi experimental design | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| CDSS characteristics | |||
| Rule-based | 22 (52.4) | 11 (44.0) | 11 (64.7) |
| Guidelines | 13 (31.0) | 9 (36.0) | 4 (23.5) |
| AI-based | 3 (7.1) | 2 (8.0) | 1 (5.9) |
| Digital checklist | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Predictive models | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Platform for CDSS delivery | |||
| Integrated into EHRs | 18 (42.9) | 11 (44.0) | 7 (41.2) |
| Web-based software | 9 (21.4) | 6 (24.0) | 3 (17.6) |
| Smartphone-based application | 4 (9.5) | 2 (8.0) | 2 (11.8) |
| Integrated with CPOE | 3 (7.1) | 2 (8.0) | 1 (5.9) |
| Integrated into a vital sign monitor | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| NA | 7 (16.7) | 4 (16.0) | 3 (17.6) |
| Baseline patient complexity | |||
| High complexity | |||
| Chronic kidney disease | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Need for feeding tube | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Children | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Polymedicated with ≥10 drugs | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Need for resuscitation | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Therapy with high-risk drugs | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Cancer | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Medium complexity | |||
| Infectious disease | 3 (7.1) | 2 (8.0) | 1 (5.9) |
| Opioid use disorder | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| Need for epidural anaesthesia | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| Lower complexity | |||
| Unspecified comorbidities | 6 (14.3) | 2 (8.0) | 4 (23.5) |
| Polymedicated with ≥4 drugs | 3 (7.1) | 1 (4.0) | 2 (11.8) |
| Asthma | 2 (4.8) | 2 (8.0) | 0 (0.0) |
| Diabetes | 2 (4.8) | 1 (4.0) | 1 (5.9) |
| COPD | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| Adrenal insufficiency | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| Neuropathy | 1 (2.4) | 0 (0.0) | 1 (5.9) |
| NA | 8 (19.0) | 6 (24.0) | 2 (11.8) |
| Duration of the intervention (after CDSS implementation) | |||
| ≤6 months | 12 (28.6) | 9 (36.0) | 3 (17.6) |
| 7–12 months | 5 (11.9) | 5 (11.9) | 0 (0.0) |
| 13–18 months | 4 (9.5) | 1 (4.0) | 3 (17.6) |
| 19–24 months | 6 (14.3) | 3 (12.0) | 3 (17.6) |
| >24 months | 7 (16.7) | 5 (11.9) | 2 (11.8) |
| NA | 8 (19.0) | 2 (8.0) | 6 (35.3) |
| CDSS users | |||
| Multidisciplinary team | 18 (42.9) | 10 (40.0) | 8 (47.1) |
| Clinician | 10 (23.8) | 4 (16.0) | 6 (35.3) |
| Pharmacist and/or pharmacy technician | 7 (16.7) | 6 (24.0) | 1 (5.9) |
| GP | 3 (7.1) | ||
| Researcher | 3 (7.1) | 3 (12.0) | 0 (0.0) |
| Nurse | 1 (2.4) | 1 (4.0) | 0 (0.0) |
| Pharmacist participation | |||
| No | 24 (57.1) | 12 (48.0) | 12 (70.6) |
| Yes | 18 (42.9) | 13 (52.0) | 5 (11.9) |
AI, artificial intelligence; CDSS, Clinical Decision Support System; COPD, chronic obstructive pulmonary disease; CPOE, Computerised Physician Order Entry; EHR, electronic health record; GP, general practitioner; NA, not available; RCT, randomised controlled trial.