Barriers and facilitators of health professionals in adopting digital health-related tools for medication appropriateness: A systematic review.

Objective: Digital health is described as the use and development of all types of digital technologies to improve health outcomes. It could be used to prevent medication errors, a priority for health systems worldwide. However, the adoption of such tools remains slow. This study aims to identify factors (attitudes, knowledge and beliefs) acting as barriers and/or facilitators reported by healthcare professionals (HCPs) for the adoption of digital health-related tools for medication appropriateness. Methods: A systematic review was performed by searching the literature in the MEDLINE PubMed, and EMBASE scientific databases for original articles regarding qualitative and quantitative data. Results: Fifteen articles were included and a total of 125 barriers and 108 facilitators were identified, consolidated and categorized into technical (n = 48), organizational (n = 12), economical (n = 4), user-related (n = 34), and patient-related (n = 8) components. The most often reported barriers and facilitators were technical component-related ones concerning the need for additional training (n = 6), the time consumed (n = 6), and the easy way of using or learning how to use the tools (n = 9), respectively. Regarding setting analysis, agreement with clinical decision recommendations and impact on the doctor-patient relationship were more valued in primary care, while the user interface and system design were in the hospital. Conclusions: The barriers and facilitators identified in this study provide relevant information to developers and it can be used as a starting point for the designing of successful digital health-related tools, specifically related to medication appropriateness. Future research includes economic evaluation-focused studies and in-depth case studies of specific barriers and facilitators.

Iopromide safety assessment in a radiology department: A seven-year retrospective characterization of adverse events.

BACKGROUND: Since the mid-20th century, contrast agents have been widely used in radiology due to their ability to provide high-definition radiographic images and greater precision in diagnostic exams. Different types of contrast agents are used in image diagnosis, namely radiological media. Despite being considered safe, there are still uncertainties about their safety profile, interactions, and incidence of adverse drug reactions in real-world settings. OBJECTIVE: To characterise the pattern of adverse events, during 7 years, in a radiology unit. METHODS: We performed a retrospective observational and descriptive study at an Image Center in Portugal between August 2012 and October 2019. A total of 77,449 computed tomography (CT) were registered, and from those 15,640 cases of iopromide were used as a contrast agent. The authors have accessed, under the authorization, the data of adverse events and procedures after the event. RESULTS: Most of the hypersensitivity events were immediate or with a short time of onset, with the majority of cases developing events with skin involvement and mild degree, where the most common events were papules (n = 60), pruritus (n = 42), erythema (n = 27) and urticaria (n = 14). Severe events, including hypersensitivity, were mainly represented by vomiting (n = 11), stridor (n = 8), breathing difficulties (n = 7) and syncope (n = 3). Abdominal-pelvic CT exam presented a higher frequency of adverse events. CONCLUSION: Despite all the current information about iopromide usage, the utilization of this agent is not abstent of risks and its safety profile not fully established. Most frequent symptoms were local, as skin adverse events, including papules, pruritus and erythema. Common medications used to treat or control adverse events were frequently hydrocortisone, clemastine and methylprednisolone.

[Use of antihypertensive drugs in Spain (1995-2001)]. / Utilización de antihipertensivos en España (1995-2001).

OBJECTIVES: In the last few years there have been changes in the pattern of consumption of antihypertensive drugs in Spain. This study aimed to describe the pattern of use in Spain from 1995 to 2001, its compliance with guidelines, and its economic impact. An aim of particular interest for our study was the impact of angiotensin II receptor antagonists on the consumption of the drugs from other therapeutic subgroups. PATIENTS AND METHOD: Information on drug utilization was obtained from the ECOM database of the Spanish Ministry of Health, which records the number of packages charged to the National Health System. Data were expressed in defined daily dose (DDD) and DDD per 1000 inhabitants per day (DHD). RESULTS: Antihypertensive consumption in Spain increased from 113.1 DHD in 1995 to 182.8 in 2001 (an increase of 61.65%). In 2001, angiotensin II receptor antagonists accounted for 25% of the costs and 14% of the consumption. Overall, costs increased from 646.42 million euros in 1995 to 1144.77 million euros in 2001. CONCLUSIONS: The consumption of antihypertensive drugs in Spain has increased remarkably in the last 7 years. Likewise, costs have increased proportionately, although the contributions of different therapeutic subgroups have been unequal. The impact of angiotensin II receptor antagonists has been considerable, both on consumption and on costs.