A comparative evaluation of two clinical decision support systems for safer prescribing in older adults: an exploratory single-patient case study

Introduction: The geriatric population face a heightened risk of adverse drug events due to multimorbidity and polypharmacy, yet clinical decision support systems used in community pharmacies often lack explicit geriatric prescribing criteria. Methods: This exploratory, proof-of-concept single-patient study evaluated the real-world performance of a newly developed Integrated Clinical Decision Support Tool (PIM Tool), which incorporates the EU (7)-PIM and EURO-FORTA frameworks, and compared it with e-Pharmacist, the clinical decision support module currently used in Estonia's national pharmacy system. A single patient case from the EuroAgeism dataset was analysed, with medications assessed independently in both systems. Results: The PIM Tool identified potentially inappropriate medications based on age, diagnosis, treatment duration, and cumulative risk, whereas e-Pharmacist primarily detected drug-drug interactions, organ-specific cautions, and dose adjustment needs. Several clinically relevant risks, including age-inappropriate long-term therapies and cumulative sedative burden, were primarily identified by the PIM Tool, while interaction-related and monitoring-related risks were captured exclusively by e-Pharmacist. Patient-reported symptoms appeared to align with overlapping risk patterns identified when outputs from both systems were considered together. Discussion: These findings suggest that clinical decision support systems based on geriatric prescribing criteria and those focused on interaction screening may capture different but complementary medication-related risks. Using both approaches together may support a more comprehensive identification of medication-related problems and deprescribing opportunities in community-dwelling older adults.