OBJECTIVE To evaluate the appropriateness of dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases after implementation of an automated prescription alert system. METHODS We examined dopamine receptor antagonist prescriptions in hospitalized patients with dopamine-requiring diseases and physician response to an automated drug contraindication alert system at Barnes-Jewish Hospital from 2009 to 2013. A detailed review of patient medical records was performed for all alert events generated when a physician prescribed a dopamine receptor antagonist concurrently with a dopamine receptor agonist in hospitalized patients. Two movement disorders neurologists determined the appropriateness of each prescription, based on patient medical history, through consensus. Physician response to alert was compared by indication for the prescription and physician specialty. RESULTS Of 237 orders, 197 (83.1%) prescriptions for dopamine receptor antagonists were considered inappropriate. The prevalence of inappropriate dopamine receptor antagonist prescriptions per levodopa prescriptions was 16.10% (95% confidence interval 9.47, 22.73) in psychiatry, 7.51% (6.16, 8.86) in general medicine, 6.14% (4.49, 7.79) in the surgical specialties, and 0.85% (0.46, 1.25) in the neurologic/neurosurgical specialties. Of the inappropriate prescriptions, 146 (74.1%) were continued despite the alert. The strongest predictor of discontinuation of dopamine receptor antagonist medications was use of the medication to treat nausea or emesis (p < 0.001). CONCLUSIONS Despite successfully identifying instances when dopamine antagonists were prescribed to patients with dopamine-requiring diseases, the alert system modestly affected physician prescribing behavior, highlighting the need for improved education of health care providers.

中文翻译：

---

左旋多巴治疗的疾病患者对药物警报系统的内科医生反应。

目的在实施自动处方警报系统后，评估多巴胺受体拮抗剂处方在住院多巴胺疾病患者中的适用性。方法我们检查了2009年至2013年间在Barnes-Jewish医院住院的需要多巴胺疾病的患者中的多巴胺受体拮抗剂处方，以及医生对自动禁忌症警报系统的反应。对患者医疗记录进行了详细的回顾，以分析当发生以下情况时产生的所有警报事件一位医生在住院患者中同时开了多巴胺受体拮抗剂和多巴胺受体激动剂。两位运动障碍神经科医生基于患者的病史，通过共识确定了每种处方的适用性。通过对处方和医师专长的指征比较医师对警报的反应。结果在237份订单中，有197份（83.1％）的多巴胺受体拮抗剂处方被认为是不合适的。每个左旋多巴处方中不适当的多巴胺受体拮抗剂处方的发生率在精神病学中为16.10％（95％置信区间9.47，22.73），在普通医学中为7.51％（6.16，8.86），在外科专业中为6.14％（4.49，7.79），以及神经科/神经外科专业中的0.85％（0.46，1.25）。尽管有警报，在不适当的处方中，仍有146例（74.1％）继续使用。多巴胺受体拮抗剂药物停用的最强预测因素是使用该药物治疗恶心或呕吐（p <0.001）。