Problems detected by a ripple-down rules based medication review decision support system: are they relevant?

A ripple-down rules based clinical decision support system to detect drug-related problems (DRPs) has been previously designed and discussed. A commercial implementation of this system (MRM) was evaluated to determine how many additional DRPs would be identified by the reviewing pharmacist when supported by MRM, and whether these additional DRPs were clinically relevant. The DRPs identified by pharmacists were compared against those found by MRM on a dataset of 570 medication review cases, MRM found 2854 DRPs, pharmacists found 1974 DRPs, yet only 389 of the problems that MRM found were also found by the pharmacist. A sample of 20 of these cases were assessed by an expert panel to determine if the DRPs found by each source were clinically relevant. It was determined that DRPs found by both sources were clinically relevant. It is estimated that a pharmacist supported by MRM will find 2.25 times as many DRPs.