Hospital Pharmacists' Perspectives on Clinical Decision Support Systems: Perceived Usefulness, Barriers, and Willingness to Adopt in Non-Implementing Hospitals in Rizal Province, Philippines

Abstract

Clinical decision support systems (CDSS) can improve medication safety, yet implementation remains limited in some Philippine hospitals. This study examined hospital pharmacists' perceived usefulness of CDSS, willingness to adopt, trust requirements, and anticipated barriers in non-implementing hospitals in Rizal Province, Philippines. A convergent mixed-methods, cross-sectional survey was conducted among 84 licensed hospital pharmacists using a content-validated 15-item Likert questionnaire and six open-ended questions, analysed descriptively and thematically. Across perceived-usefulness items, 88.10%–92.86% agreed that CDSS could improve medication safety, risk detection, and efficiency. Trust was conditional on transparency: 82.14%–85.71% reported greater trust or willingness when systems provided clinical rationales, evidence links or grading, and auditable calculation pathways. Although no respondent's hospital had a CDSS, 78.57% reported a general tendency to override electronic alerts from other tools to maintain clinical speed; this is not a CDSS override rate but signals a risk if future notifications are poorly stratified. Self-reported CDSS knowledge was not associated with age (Fisher-Freeman-Halton exact test, $p = 0.389$). The main barriers were software and infrastructure costs (86.90%) and insufficient IT support (82.14%); qualitative findings added paper-based infrastructure, budget constraints, understaffing, and demands for low-friction interfaces, tiered alerting, and preserved professional judgment. Pharmacists viewed CDSS as useful and were conditionally willing to adopt it. Implementation should prioritize technical support, transparent recommendations, and workflow-compatible alert design.