Implications of parenteral chemotherapy dose standardisation in a tertiary oncology centre.

BACKGROUND: Dose banding parenteral chemotherapy has the potential to optimise aseptic unit capacity and reduce drug expenditure without compromising the service provided. METHODS: Dose banding tables from NHS England were implemented into the electronic chemotherapy prescribing system. Compliance to the dose bands was analysed and submitted quarterly. Analysis of drug expenditure, drug use and cost per milligram data was also collected. RESULTS: Expenditure on the 17 drugs identified in the 2016/17 dose standardisation CQUIN reduced by approximately £100,000 per month over the CQUIN despite an increase in the number of prescribed doses of these drugs. At the beginning of the year, the percentage of work compounded in house was 60%, which was reduced to 51% of total workload at the end of the year due to outsourcing commonly prescribed doses from commercial pharmaceutical aseptic manufacturers. CONCLUSION: Dose banding parenteral chemotherapy is an efficient cost-saving strategy which also can help to increase the capacity of the aseptic unit.

Using pharmacy management systems for research: survival outcomes for lenalidomide in multiple myeloma in the clinical setting.

Background Health records can be used to measure medicine use and health outcomes. The public subsidy of lenalidomide in Australia was based on two phase III trials showing improved survival. Objective To use hospital pharmacy information management systems to determine survival outcomes for lenalidomide as a second line treatment in relapsed or refractory multiple myeloma (RRMM) patients. Setting Five public hospitals in Queensland, Australia. Method We extracted data on medicine use and survival for RRMM patients planned to start lenalidomide from pharmacy management and pathology databases. Descriptive statistical analyses (Kaplan-Meier curves) were used to calculate overall survival. Main outcome measure Overall survival. Results There were 136 patients who received at least one lenalidomide dose and 2234 cycles were ordered. The median age was 69 years and 54% were male. Two lenalidomide containing protocols were considered: 90% of patients had lenalidomide plus dexamethasone; 18% had lenalidomide plus dexamethasone with cyclophosphamide. The median starting lenalidomide dose was 20 mg (range 4.3-25 mg) on days 1-21 of a 28-day cycle. Median time on treatment 9.4 months (range 0.5-71.7 months). Median overall survival was 45.4 months (range 12.0-70.5 months). Conclusion The median survival in our study compared favourably to clinical trials. Patients and clinicians can be reassured that outcomes in this clinical setting are as good as those observed in trials.

An evaluation of e-prescribing at a national level.

OBJECTIVE: The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled. MATERIALS AND METHODS: The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies. RESULTS: According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains. CONCLUSION: The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.

The new Greek national e-prescription system: an effective tool for improving quality of care and containing medication costs.

The national e-prescription system of Greece was first introduced in 2010 and already covers more than 80% of all prescriptions prescribed today (more than 5 million per month). Its introduction provided a powerful tool for improving patient services and public health planning. The system is also already a valuable source of planning, control and transparency data for the Greek healthcare system. In addition, the experience from its application at national level in Greece has also shown that e-Prescription systems can also provide a very useful tool for better administrative control and for containing unnecessary expenditure related to medication use.

The assisted electronic prescription in patients hospitalised in a chest diseases ward.

Patient medical care requires a level of individualised care, so technological support is becoming increasingly necessary, if not essential. Even so, the effort required to apply new technologies in the health system is not always sufficient, taking into account that they could be key factors for the safety of the patient. Treatments are often prescribed manually, which could lead to errors due to ambiguity of the prescriptions, illegibility, calculation errors or transcription errors. The increasing sophistication of computer systems and programs used in the hospital care setting can be fundamental in reducing risks for the patient, detecting and correcting errors, contributing to making decisions using help support and reducing costs in the long-term. Polymedicated patients with the usual multiple diseases in medical specialty departments, such as Chest Diseases, can particularly benefit from the application of these new technologies.

Exploring health information technology innovativeness and its antecedents in Canadian hospitals.

OBJECTIVES: The primary aim of this study was to assess the antecedents of health information technology (HIT) innovativeness in public hospitals. To do so, we built upon our own previous work to relate the level of HIT innovativeness to organizational capacity characteristics. METHODS: We conducted a survey of chief information officers (CIOs) in public hospitals in the two largest Canadian provinces to identify the level of HIT innovativeness in these settings and test nine research hypotheses derived from the proposed research model. RESULTS: A total of 106 completed questionnaires were received, which represents a response rate of 52%. Our findings indicate strong support for the research model. Seven out of nine hypotheses were supported indicating a significant relationship between HIT innovativeness and structural, financial, leadership, and knowledge sharing capacity characteristics. Results also reveal a moderate level of HIT innovativeness in the surveyed hospitals, with more emphasis on administrative systems and their integration than on clinical systems and emerging technologies. CONCLUSIONS: This study demonstrates that organizational characteristics are related to HIT innovativeness; this relationship holds irrespective of the public or private nature of hospitals.