{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T12:24:03Z","timestamp":1773231843717,"version":"3.50.1"},"reference-count":23,"publisher":"Georg Thieme Verlag KG","issue":"05","funder":[{"name":"National Library of Medicine Biomedical Informatics and Data Science Research Training Grant","award":["T15 LM007092"],"award-info":[{"award-number":["T15 LM007092"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Appl Clin Inform"],"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>\n          Objective\u2003We examined clinical decision support (CDS) alerts designed specifically for medication shortages to characterize and assess provider behavior in response to these short-term clinical situations.<\/jats:p><jats:p>\n          Materials and Methods\u2003We conducted a retrospective analysis of the usage of medication shortage alerts (MSAs) that included at least one alternative medication suggestion and were active for 60 or more days during the 2-year study period, January 1, 2018 to December 31, 2019, in a large health care system. We characterized ordering provider behavior in response to inpatient MSAs. We then developed a linear regression model to predict provider response to alerts using the characteristics of the ordering provider and alert frequency groupings.<\/jats:p><jats:p>\n          Results\u2003During the study period, there were 67 MSAs in use that focused on 42 distinct medications in shortage. The MSAs suggested an average of 3.9 alternative medications. Adjusting for the different alerts, fellows (p\u2009=\u20090.004), residents (p\u2009=\u20090.03), and physician assistants (p\u2009=\u20090.02) were less likely to accept alerts on average compared with attending physicians. Further, female ordering clinicians (p\u2009&lt;\u20090.001) were more likely to accept alerts on average compared with male ordering clinicians.<\/jats:p><jats:p>\n          Conclusion\u2003Our findings demonstrate that providers tended to reject MSAs, even those who were sometimes flexible about their responses. The low overall acceptance rate supports the theory that alerts appearing at the time of order entry may have limited value, as they may be presented too late in the decision-making process. Though MSAs are designed to be attention-grabbing and higher impact than traditional CDS, our findings suggest that providers rarely change their clinical decisions when presented with these alerts.<\/jats:p>","DOI":"10.1055\/s-0041-1740257","type":"journal-article","created":{"date-parts":[[2021,12,2]],"date-time":"2021-12-02T00:18:08Z","timestamp":1638404288000},"page":"1144-1149","source":"Crossref","is-referenced-by-count":5,"title":["Low Efficacy of Medication Shortage Clinical Decision Support Alerts"],"prefix":"10.1055","volume":"12","author":[{"given":"Nicole M.","family":"Benson","sequence":"additional","affiliation":[{"name":"McLean Hospital, Belmont, Massachusetts, United States"},{"name":"Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, United States"},{"name":"Harvard Medical School, Boston, Massachusetts, United States"}]},{"given":"Caryn","family":"Belisle","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"}]},{"given":"David W.","family":"Bates","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, United States"},{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"},{"name":"Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States"}]},{"given":"Hojjat","family":"Salmasian","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, Massachusetts, United States"},{"name":"Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States"}]}],"member":"194","published-online":{"date-parts":[[2021,12,1]]},"reference":[{"issue":"11","key":"ref1","first-page":"740","article-title":"The drug shortage crisis in the United States: causes, impact, and management strategies","volume":"36","author":"C L Ventola","year":"2011","journal-title":"P&T"},{"key":"ref4","first-page":"586","article-title":"Why big pharma has abandoned antibiotics","volume":"2020","author":"B Plackett","year":"2020","journal-title":"Nature"},{"issue":"05","key":"ref7","doi-asserted-by":"crossref","first-page":"e0215837","DOI":"10.1371\/journal.pone.0215837","article-title":"The impacts of medication shortages on patient outcomes: a scoping review","volume":"14","author":"J M Phuong","year":"2019","journal-title":"PLoS One"},{"issue":"05","key":"ref8","doi-asserted-by":"crossref","first-page":"e00508","DOI":"10.1002\/prp2.508","article-title":"Medication stewardship using computerized clinical decision support: a case study on intravenous immunoglobulins","volume":"7","author":"D Tsapepas","year":"2019","journal-title":"Pharmacol Res Perspect"},{"key":"ref9","first-page":"S103","article-title":"Clinical decision support: a 25 year retrospective and a 25 year vision","author":"B Middleton","year":"2016","journal-title":"Yearb Med Inform"},{"issue":"02","key":"ref10","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1055\/s-0041-1722916","article-title":"A narrative review of clinical decision support for inpatient clinical pharmacists","volume":"12","author":"L Yan","year":"2021","journal-title":"Appl Clin Inform"},{"issue":"03","key":"ref11","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.mayocp.2013.11.014","article-title":"Drug shortages: a complex health care crisis","volume":"89","author":"E R Fox","year":"2014","journal-title":"Mayo Clin Proc"},{"issue":"03","key":"ref12","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1055\/s-0041-1730030","article-title":"Evaluation of clinical decision support to reduce sedative-hypnotic prescribing in older adults","volume":"12","author":"N N Joglekar","year":"2021","journal-title":"Appl Clin Inform"},{"issue":"05","key":"ref13","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1055\/s-0040-1721398","article-title":"Reducing inappropriate outpatient medication prescribing in older adults across electronic health record systems","volume":"11","author":"M P Friebe","year":"2020","journal-title":"Appl Clin Inform"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1055\/s-0040-1701678","article-title":"Is the climb worth the view? 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