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Wohlfeiler MB, Weber RP, Brunet L, Fusco JS, Uranaka C, Cochran Q, Palma M, Evans T, Millner C, Fusco GP. HIV retention in care: results and lessons learned from the Positive Pathways Implementation Trial. BMC PRIMARY CARE 2022; 23:297. [PMID: 36424550 PMCID: PMC9685944 DOI: 10.1186/s12875-022-01909-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sustained, routine care is vital to the health of people with HIV (PWH) and decreasing transmission of HIV. We evaluated whether the identification of PWH at-risk of falling out of care and prompts for outreach were effective in retaining PWH in care in the United States. METHODS In this cluster randomized controlled trial, 20 AIDS Healthcare Foundation Healthcare Centers (HCCs) were randomized to the intervention (n = 10) or control (n = 10) arm; all maintained existing retention efforts. The intervention included daily automated flags in CHORUS™, a mobile app and web-based reporting solution utilizing electronic health record data, that identified PWH at-risk of falling out of care to clinic staff. Among flagged PWH, the association between the intervention and visits after a flag was assessed using logistic regression models fit with generalized estimating equations (independent correlation structure) to account for clustering. To adjust for differences between HCCs, models included geographic region, number of PWH at HCC, and proportions of PWH who self-identified as Hispanic or had the Ryan White Program as a payer. RESULTS Of 15,875 PWH in care, 56% were flagged; 76% (intervention) and 75% (control) resulted in a visit, of which 76% were within 2 months of the flag. In adjusted analyses, flags had higher odds of being followed by a visit (odds ratio [OR]: 1.08, 95% confidence interval [CI]: 0.97, 1.21) or a visit within 2 months (OR: 1.07, 95% CI: 0.97, 1.17) at intervention than control HCCs. Among at-risk PWH with viral loads at baseline and study end, the proportion with < 50 copies/mL increased in both study arms, but more so at intervention (65% to 74%) than control (62% to 67%) HCCs. CONCLUSION Despite challenges of the COVID-19 pandemic, adding an intervention to existing retention efforts, and the reality that behavior change takes time, PWH flagged as at-risk of falling out of care were marginally more likely to return for care at intervention than control HCCs and a greater proportion achieved undetectability. Sustained use of the retention module in CHORUS™ has the potential to streamline retention efforts, retain more PWH in care, and ultimately decrease transmission of HIV. TRIAL REGISTRATION The study was first registered at Clinical Trials.gov (NCT04147832, https://clinicaltrials.gov/show/NCT04147832 ) on 01/11/2019.
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Affiliation(s)
| | | | | | | | - Christine Uranaka
- grid.427827.c0000 0000 8950 9874AIDS Healthcare Foundation, Los Angeles, CA USA
| | - Quateka Cochran
- grid.427827.c0000 0000 8950 9874AIDS Healthcare Foundation, Los Angeles, CA USA
| | - Monica Palma
- grid.427827.c0000 0000 8950 9874AIDS Healthcare Foundation, Los Angeles, CA USA
| | | | - Carl Millner
- grid.427827.c0000 0000 8950 9874AIDS Healthcare Foundation, Los Angeles, CA USA
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Shahmoradi L, Safdari R, Ahmadi H, Zahmatkeshan M. Clinical decision support systems-based interventions to improve medication outcomes: A systematic literature review on features and effects. Med J Islam Repub Iran 2021; 35:27. [PMID: 34169039 PMCID: PMC8214039 DOI: 10.47176/mjiri.35.27] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Clinical decision support systems (CDSSs) interventions were used to improve the life quality and safety in patients and also to improve practitioner performance, especially in the field of medication. Therefore, the aim of the paper was to summarize the available evidence on the impact, outcomes and significant factors on the implementation of CDSS in the field of medicine. Methods: This study is a systematic literature review. PubMed, Cochrane Library, Web of Science, Scopus, EMBASE, and ProQuest were investigated by 15 February 2017. The inclusion requirements were met by 98 papers, from which 13 had described important factors in the implementation of CDSS, and 86 were medicated-related. We categorized the system in terms of its correlation with medication in which a system was implemented, and our intended results were examined. In this study, the process outcomes (such as; prescription, drug-drug interaction, drug adherence, etc.), patient outcomes, and significant factors affecting the implementation of CDSS were reviewed. Results: We found evidence that the use of medication-related CDSS improves clinical outcomes. Also, significant results were obtained regarding the reduction of prescription errors, and the improvement in quality and safety of medication prescribed. Conclusion: The results of this study show that, although computer systems such as CDSS may cause errors, in most cases, it has helped to improve prescribing, reduce side effects and drug interactions, and improve patient safety. Although these systems have improved the performance of practitioners and processes, there has not been much research on the impact of these systems on patient outcomes.
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Affiliation(s)
- Leila Shahmoradi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Safdari
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Ahmadi
- OIM Department, Aston Business School, Aston University, Birmingham B4 7ET, United Kingdom
| | - Maryam Zahmatkeshan
- Noncommunicable Diseases Research Center, School of Medicine, Fasa University of Medical Sciences, Fasa, Iran
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Snyder ME, Adeoye-Olatunde OA, Gernant SA, DiIulio J, Jaynes HA, Doucette WR, Russ-Jara AL. A user-centered evaluation of medication therapy management alerts for community pharmacists: Recommendations to improve usability and usefulness. Res Social Adm Pharm 2020; 17:1433-1443. [PMID: 33250363 DOI: 10.1016/j.sapharm.2020.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 09/14/2020] [Accepted: 10/28/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Community pharmacists provide comprehensive medication reviews (CMRs) through pharmacy contracts with medication therapy management (MTM) vendors. These CMRs are documented in the vendors' web-based MTM software platforms, which often integrate alerts to assist pharmacists in the detection of medication therapy problems. Understanding pharmacists' experiences with MTM alerts is critical to optimizing alert design for patient care. OBJECTIVES The objectives of this study were to 1) assess the usability and usefulness of MTM alerts for MTM vendor-contracted community pharmacists and 2) generate recommendations for improving MTM alerts for use by community pharmacists. METHODS This was a convergent, parallel mixed-methods evaluation of data collected from 3 sources, with individual pharmacists contributing data to one or more sources: 1) community pharmacists' submissions of observational data about MTM alerts encountered during routine MTM provision, 2) videos of naturalistic usability testing of MTM alerts, and 3) semi-structured interviews to elicit pharmacists' perspectives on MTM alert usefulness and usability. MTM alert data submitted by pharmacists were summarized with descriptive statistics. Usability testing videos were analyzed to determine pharmacists' time spent on MTM alerts and to identify negative usability incidents. Interview transcripts were analyzed using a hybrid approach of deductive and inductive codes to identify emergent themes. Triangulation of data (i.e., determination of convergence/divergence in findings across all data sources) occurred through investigator discussion and identified overarching findings pertaining to key MTM alert challenges. These resulted in actionable recommendations to improve MTM alerts for use by community pharmacists. RESULTS Collectively, two and four overarching key challenges pertaining to MTM alert usability and usefulness, respectively, were identified, resulting in 15 actionable recommendations for improving the design of MTM alerts from a user-centered perspective. CONCLUSIONS Recommendations are expected to inform enhanced MTM alert designs that can improve pharmacist efficiency, patient and prescriber satisfaction with MTM, and patient outcomes.
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Affiliation(s)
- Margie E Snyder
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Omolola A Adeoye-Olatunde
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - Stephanie A Gernant
- University of Connecticut School of Pharmacy, 69 North Eagleville Rd, U-3095, Storrs, CT, 06269, USA.
| | - Julie DiIulio
- Applied Decision Science, 1776 Mentor Ave. #424, Cincinnati, OH, 45212, USA.
| | - Heather A Jaynes
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
| | - William R Doucette
- University of Iowa College of Pharmacy, 339 CPB 180 S. Grand Avenue, Iowa City, IA, 52242, USA.
| | - Alissa L Russ-Jara
- Purdue University College of Pharmacy, Fifth Third Bank Building, 640 Eskenazi Avenue, Indianapolis, IN, 46202, USA.
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Baudouin A, Herledan C, Poletto N, Guillemin MD, Maison O, Garreau R, Chillotti L, Parat S, Ranchon F, Rioufol C. Economic impact of clinical pharmaceutical activities in hospital wards: A systematic review. Res Social Adm Pharm 2020; 17:497-505. [PMID: 32819880 DOI: 10.1016/j.sapharm.2020.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The positive impact of clinical pharmacy services (CPS) in improving clinical outcomes such as reduction of drug related problems is well demonstrated. Despite these results, the deployment of these activities is not systematically observed in the hospital setting. OBJECTIVES This systematic review first aimed to describe existing evidence regarding economic evaluation of ward-based CPS focusing on the entire treatment of a patient in a hospital setting. Secondly, the quality of economic evaluations of existing evidence was assessed. METHODS A comprehensive literature search was performed in PubMed/Medline, Science Direct and the NHS Economic Evaluation databases from January 2000 to March 2019. English or French language articles describing an economic evaluation of ward-based CPS on inpatients in hospital settings were included. Articles not describing a single study, dealing with a CPS not considering the entire medication regimen of the patient or presenting both inpatient and outpatient CPS were excluded. Selected articles were analyzed according to Drummond's check-list for assessing economic evaluations. RESULTS Forty-one studies were included. About one third were American publications. CPS implemented in ICU represented about half of the selected articles. Pharmacist-to-bed ratios varied according to countries and care unit type with the most favorable ratios in ICU and in American studies. Cost-avoidance was mostly used to express economic impact and ranged from €1579 to €3,089 328. Studies yielding the greater economic impact were conducted in the USA with implementation of full-time equivalents pharmacists or establishing of collaborative practice agreements. Only 6 articles dealt correctly with at least 7 of the 10 Drummond's checklist assessment criteria. CONCLUSION This review suggests that the existing evidence is not sufficient to conclude to a positive economic impact of CPS conducted according to clinical pharmacy guidelines. Funding resources, remuneration of clinical pharmacy activities and provision of standardized national clinical and economic databases appear to be essential evolutions to improve CPS development.
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Affiliation(s)
- Amandine Baudouin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Chloé Herledan
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Nicolas Poletto
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Marie-Delphine Guillemin
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Ophélie Maison
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Romain Garreau
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Louis Chillotti
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Stéphanie Parat
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France
| | - Florence Ranchon
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France.
| | - Catherine Rioufol
- Hospices Civils de Lyon, Groupement Hospitalier Sud, Pharmacie à Usage Intérieur, 165 Chemin Du Grand Revoyet, Pierre-Bénite Cedex, 69495, France; EMR3738, Université de Lyon, Lyon, France
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Fernández-Oliveira C, Martínez-Roca C, Ávila-Álvarez A, Balboa-Barreiro V, Giménez-Arufe V, Yáñez-Gómez P, Hermida-Bouzas MC, Martín-Herranz I. Impact of introducing assisted electronic prescription on paediatric patient safety. An Pediatr (Barc) 2020. [DOI: 10.1016/j.anpede.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Fernández Oliveira C, Martínez Roca C, Ávila Álvarez A, Balboa Barreiro V, Giménez Arufe V, Yáñez Gómez P, Hermida Bouzas MC, Martín Herranz I. [Impact of introducing assisted electronic prescription on paediatric patient safety]. An Pediatr (Barc) 2020; 93:103-110. [PMID: 32061530 DOI: 10.1016/j.anpedi.2019.12.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 12/25/2019] [Accepted: 12/27/2019] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE There have been very few studies on the effect of assisted electronic prescription on paediatric patient safety. The objective of this study is to compare medication errors that occurred before and after its introduction in a tertiary hospital. MATERIAL AND METHODS A quasi-experimental comparative study of medication errors detected before and after assisted electronic prescription introduction. All treatment lines were analysed in order to detect the point in the chain where the medication error occurred, as well as its type and cause. A Delphi study was conducted on the importance of each medication error involving doctors, nurses, and pharmacists. RESULTS The study included 166 patients (83 at each stage). At least one medication error was detected in 92% in the pre-introduction phase patients (2.8±2.1 errors/patient) and 7.2% of post-introduction phase patients (0.1±0.4 errors/patient). The assisted electronic prescription led to an absolute risk reduction of 40% (95% confidence interval=35.6-44.4%). The main cause of error was lapses and carelessness in both stages. Medication errors were considered serious in 9.5% of cases in the pre-introduction phase, while all of them were mild or moderate in the post-introduction phase. CONCLUSIONS The assisted electronic prescription implementation with prescription, validation and medication administration assistance systems significantly reduces medication errors and eliminates serious errors.
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Affiliation(s)
- Carla Fernández Oliveira
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España.
| | - Cristina Martínez Roca
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Alejandro Ávila Álvarez
- Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Vanesa Balboa Barreiro
- Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Víctor Giménez Arufe
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Pedro Yáñez Gómez
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - María Carmen Hermida Bouzas
- Servicio de Pediatría, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
| | - Isabel Martín Herranz
- Servicio de Farmacia, Complexo Hospitalario Universitario de A Coruña, Servizo Galego de Saúde, A Coruña, España
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Verdoorn S, Kwint H, Hoogland P, Gussekloo J, Bouvy M. Drug‐related problems identified during medication review before and after the introduction of a clinical decision support system. J Clin Pharm Ther 2017; 43:224-231. [DOI: 10.1111/jcpt.12637] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Affiliation(s)
- S. Verdoorn
- Division of Pharmacoepidemiology & Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences (UIPS) Utrecht The Netherlands
- SIR Institute for Pharmacy Practice and Policy Leiden The Netherlands
| | - H.F. Kwint
- SIR Institute for Pharmacy Practice and Policy Leiden The Netherlands
| | - P. Hoogland
- Service Apotheek, ‘s‐Hertogenbosch The Netherlands
| | - J. Gussekloo
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands
- Department of Internal Medicine, section Gerontology and Geriatrics Leiden University Medical Center Leiden The Netherlands
| | - M.L. Bouvy
- Division of Pharmacoepidemiology & Clinical Pharmacology Utrecht Institute for Pharmaceutical Sciences (UIPS) Utrecht The Netherlands
- SIR Institute for Pharmacy Practice and Policy Leiden The Netherlands
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Makowsky MJ, Cor K, Wong T. Exploring Electronic Medical Record and Self-Administered Medication Risk Screening Tools in a Primary Care Clinic. J Manag Care Spec Pharm 2017; 23:566-572. [PMID: 28448775 PMCID: PMC10398284 DOI: 10.18553/jmcp.2017.23.5.566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Electronic medical record (EMR) screening for indicators of medication risk could improve efficiency in identifying primary care clinic patients in need of clinical pharmacist care compared with patient self-reporting. OBJECTIVES To (a) compare the performance of an EMR medication risk assessment questionnaire (MRAQ) with a self-administered (SA) MRAQ and (b) explore each tool's ability to predict indicators of health behavior, health status, and health care utilization. METHODS A prospective cohort study was conducted with 143 adults who attended an academic family medicine center and were taking ≥ 2 medications. All participants completed the 10-item SA-MRAQ, Morisky Medication Adherence Scale, Chew's health literacy screener, Stanford Health Distress Scale, and SF-36 overall rating of health. A blinded investigator completed the EMR-MRAQ and a chart review to ascertain 6 months of health care utilization. Outcome measures included the following: (a) scores from the 5- and 10-item SA-MRAQs and 5-item EMR-MRAQ; (b) sensitivity and specificity to determine the accuracy of the 5-item EMR versus the 5-item SA risk scores; (c) correlations between risk assessments and health behavior/status scales; and (d) area under the receiver operator curve to determine how well a high-risk score predicted health care utilization. RESULTS The 5-item SA-MRAQ, the 5-item EMR-MRAQ, and the 10-item SA-MRAQ categorized 52.9% (55/104), 69.2% (99/143), and 17.6% (18/102) of participants as high risk, respectively. For the 104 participants who completed both 5-item MRAQ tools, the EMR-MRAQ had a sensitivity of 81.8% and specificity of 49.0% in detecting a high-risk SA-MRAQ score. Both 5-item risk assessments showed weak correlations with health distress and overall health, while the 10-item SA-MRAQ additionally showed weak correlations with medication adherence. The EMR-MRAQ was most effective in predicting all-cause emergency room visits/hospitalization (c-statistic = 0.69; 95% CI=0.57-0.81) and high clinic utilization (≥ 4 visits per 6 months; c-statistic = 0.77; 95% CI = 0.69-0.85). The EMR-MRAQ had high sensitivities but low specificities for these health care utilization outcomes, respectively (82.6% and 33.3%; 88.9% and 42.7%). CONCLUSIONS This pilot study suggests that EMR-MRAQ screening has high sensitivity but low specificity in comparison with self-reporting and was able to discriminate between those who would and would not experience health care utilization outcomes. These results justify further development and validation of an automated EMR-based tool to predict patient-important consequences of medication-related problems. DISCLOSURES This work was funded by the Canadian Society of Hospital Pharmacists Research and Education Foundation, which had no role in the analysis or interpretation of data or the decision to submit the manuscript for publication. The authors have no conflict of interests, potential or otherwise, to report. Makowsky had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design were contributed by Makowsky and Cor. Makowsky and Wong collected the data, and data interpretation was performed by Makowsky, Cor, and Wong. The manuscript was written by Makowsky and was critically reviewed for intellectual content by Makowsky, Cor, and Wong.
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Affiliation(s)
- Mark J Makowsky
- 1 Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Ken Cor
- 1 Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Tat Wong
- 2 Grey Nuns Community Hospital, Edmonton, Alberta, Canada
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Elliott RA, Stehlik P. Identifying Inappropriate Prescribing for Older People. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2015. [DOI: 10.1002/j.2055-2335.2013.tb00284.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rohan A Elliott
- Austin Health, Centre for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University
| | - Paulina Stehlik
- Centre for Medication Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences; Monash University; Parkville Victoria
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de Wit HAJM, Mestres Gonzalvo C, Janknegt R, Schols JMGA, van der Kuy PHM. A fully automated medication review? Int J Clin Pharm 2013; 36:220-1. [PMID: 24282044 DOI: 10.1007/s11096-013-9884-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 11/11/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Hugo A J M de Wit
- Department of Clinical Pharmacy and Toxicology, Orbis Medical Centre, Dr. H van der Hoffplein 1, 6162 BG, Sittard-Geleen, The Netherlands,
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Curtain C, Bindoff I, Westbury J, Peterson G. An investigation into drug-related problems identifiable by commercial medication review software. Australas Med J 2013; 6:183-8. [PMID: 23671463 DOI: 10.4066/amj.2013.1637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Accredited pharmacists conduct home medicines reviews (HMRs) to detect and resolve potential drug-related problems (DRPs). A commercial expert system, Medscope Review Mentor (MRM), has been developed to assist pharmacists in the detection and resolution of potential DRPs. AIMS This study compares types of DRPs identified with the commercial system which uses multiple classification ripple down rules (MCRDR) with the findings of pharmacists. METHOD HMR data from 570 reviews collected from accredited pharmacists was entered into MRM and the DRPs were identified. A list of themes describing the main concept of each DRP identified by MRM was developed to allow comparison with pharmacists. Theme types, frequencies, similarity and dissimilarity were explored. RESULTS The expert system was capable of detecting a wide range of potential DRPs: 2854 themes; compared to pharmacists: 1680 themes. The system identified the same problems as pharmacists in many patient cases. Ninety of 119 types of themes identifiable by pharmacists were also identifiable by software. MRM could identify the same problems in the same patients as pharmacists for 389 problems, resulting in a low overlap of similarity with an averaged Jaccard Index of 0.09. CONCLUSION MRM found significantly more potential DRPs than pharmacists. MRM identified a wide scope of DRPs approaching the range of DRPs that were identified by pharmacists. Differences may be associated with system consistency and perhaps human oversight or human selective prioritisation. DRPs identified by the system were still considered relevant even though the system identified a larger number of problems.
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12
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Robbins GK, Lester W, Johnson KL, Chang Y, Estey G, Surrao D, Zachary K, Lammert SM, Chueh HC, Meigs JB, Freedberg KA. Efficacy of a clinical decision-support system in an HIV practice: a randomized trial. Ann Intern Med 2012; 157:757-66. [PMID: 23208165 PMCID: PMC3829692 DOI: 10.7326/0003-4819-157-11-201212040-00003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Data to support improved patient outcomes from clinical decision-support systems (CDSSs) are lacking in HIV care. OBJECTIVE To test the efficacy of a CDSS in improving HIV outcomes in an outpatient clinic. DESIGN Randomized, controlled trial. (ClinicalTrials.gov registration number: NCT00678600) SETTING Massachusetts General Hospital HIV Clinic. PARTICIPANTS HIV care providers and their patients. INTERVENTION Computer alerts were generated for virologic failure (HIV RNA level >400 copies/mL after a previous HIV RNA level ≤400 copies/mL), evidence of suboptimal follow-up, and 11 abnormal laboratory test results. Providers received interactive computer alerts, facilitating appointment rescheduling and repeated laboratory testing, for half of their patients and static alerts for the other half. MEASUREMENTS The primary end point was change in CD4 cell count. Other end points included time to clinical event, 6-month suboptimal follow-up, and severe laboratory toxicity. RESULTS Thirty-three HIV care providers followed 1011 patients with HIV. In the intervention group, the mean increase in CD4 cell count was greater (0.0053 vs. 0.0032 × 109 cells/L per month; difference, 0.0021 × 109 cells/L per month [95% CI, 0.0001 to 0.004]; P = 0.040) and the rate of 6-month suboptimal follow-up was lower (20.6 vs. 30.1 events per 100 patient-years; P = 0.022) than those in the control group. Median time to next scheduled appointment was shorter in the intervention group than in the control group after a suboptimal follow-up alert (1.71 vs. 3.48 months; P < 0.001) and after a toxicity alert (2.79 vs. >6 months; P = 0.072). More than 90% of providers supported adopting the CDSS as part of standard care. LIMITATION This was a 1-year informatics study conducted at a single hospital subspecialty clinic. CONCLUSION A CDSS using interactive provider alerts improved CD4 cell counts and clinic follow-up for patients with HIV. Wider implementation of such systems can provide important clinical benefits. PRIMARY FUNDING SOURCE National Institute of Allergy and Infectious Diseases.
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Affiliation(s)
- Gregory K Robbins
- Massachusetts General Hospital, Division of Infectious Diseases, 55 Fruit Street, Cox 5, Boston, MA 02114, USA.
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Campos Fernández de Sevilla MA, Tutau Gómez F, Gallego Úbeda M, Delgado Téllez L. [Development of integrated support software for drug validation]. FARMACIA HOSPITALARIA 2012; 36:351-5. [PMID: 22484103 DOI: 10.1016/j.farma.2011.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Revised: 11/09/2011] [Accepted: 11/20/2011] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the development of a tool to automate detection of adverse drug-related events (ADRE) in all patients in a hospital. METHOD We selected the ADRE that we wished to detect (administering drugs to patients with kidney failure and/or by enteral feeding tube) We designed software to record, process and integrate analytical results from SELENE(®) clinical history programme, treatment prescribed using Farmatools(®), and the information included in the tables we designed. RESULTS The programme allows us to automatically detect patients likely to experience the ADRE we defined, and recommends a modified treatment to the pharmacist. This new tool enables us to search for all patients who might have a specific ADRE. CONCLUSIONS The software we designed may be a useful drug validation tool.
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Bindoff I, Stafford A, Peterson G, Kang BH, Tenni P. The potential for intelligent decision support systems to improve the quality and consistency of medication reviews. J Clin Pharm Ther 2011; 37:452-8. [DOI: 10.1111/j.1365-2710.2011.01327.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Manrique-Rodríguez S, Fernández-Llamazares CM, Herranz-Alonso A, Sanjurjo-Sáez M. Bombas de infusión inteligentes: luces y sombras de una tecnología en desarrollo. Med Clin (Barc) 2011; 137:361-5. [DOI: 10.1016/j.medcli.2010.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 01/07/2010] [Accepted: 01/12/2010] [Indexed: 10/19/2022]
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Westerling AM, Haikala VE, Simon Bell J, Airaksinen MS. Logistics or patient care: Which features do independent Finnish pharmacy owners prioritize in a strategic plan for future information technology systems? J Am Pharm Assoc (2003) 2010; 50:24-31. [DOI: 10.1331/japha.2010.08176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Electronic screening of medical records to detect inpatients at risk of drug-related problems. ACTA ACUST UNITED AC 2009; 32:103-7. [DOI: 10.1007/s11096-009-9352-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Accepted: 11/25/2009] [Indexed: 11/25/2022]
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Liu S, Duffy AHB, Whitfield RI, Boyle IM. Integration of decision support systems to improve decision support performance. Knowl Inf Syst 2009. [DOI: 10.1007/s10115-009-0192-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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