Enhanced Free-Text Search for Aggregated Medication Error Report Analysis and Risk Detection.

OBJECTIVES: Detecting medication errors (MEs) and learning from them are the key elements of medication safety management in health care. While the aggregation of the data and learning across the ME reports could help detect and manage organizational risks, the inconsistent and partly missing structural data complicate the analysis. The objective of this study was to examine whether an analysis of free-text data of aggregated ME reports could contribute to the detection of organizational risks. METHODS: A retrospective, cross-sectional analysis of ME reports from a patient safety incident reporting system in a tertiary hospital 2017-2021. Clustering of characteristics and variables of ME reports with an enhanced free-text search of the 10 most frequent active substances (TOP10) related to ME reports using Microsoft Excel. Validity analysis of the four most frequent active substances of the search results (TOP4). Evaluation of the possible impact of the enhanced free-text search method on ME report analysis and risk detection. RESULTS: The enhanced free-text search increased significantly the number of relevant ME reports of TOP10 active substances from 698 reports to 1578 reports. The validity of the enhanced free-text search results in TOP4 active substances was more than 74%. The enhanced free-text search revealed also new ME findings. CONCLUSIONS: Enhanced free-text search can contribute to the aggregate analysis of clustered ME reports and to the improvement of ME risk detection. The enhanced free-text search method enables more comprehensive analysis of the free-text data with commonly available software and provides new insights into medication safety improvement.

Use of primary health care services among older patients with and without diabetes.

BACKGROUND: The aim of this study was to compare the utilization of primary healthcare services by older patients with and without type 2 diabetes. METHODS: Electronic patient records were used to identify persons over 65 years of age with a diagnosis of diabetes. Two age- and sex-adjusted controls without diabetes were extracted for each person with diagnosis of diabetes. A health questionnaire was sent by mail to 527 people with diabetes and 890 controls. Of the persons who answered the questionnaire, 518 persons were randomly selected to participate in a health examination. The study group in this analysis consisted of 187 persons with diabetes and 176 persons without diabetes who attended the health examination. The data on primary health care utilization were extracted from electronic patient records one year before and one after the health examination. RESULTS: Before the onset of the study, the patients with diabetes had more doctor's appointments (p < 0.001), nurse's appointments (< 0.001) and laboratory tests taken (p < 0.001) than those without diabetes After 1-year follow-up period the patients with diabetes had more doctor's appointments (p = 0.002), nurse's appointments (p = 0.006), laboratory tests taken (p = 0.006) and inpatient care at the community hospital (p = 0.004) than patients without a diagnosis of type 2 diabetes. The use of the community hospital increased significantly among patients with diabetes (ratio 2.50; 95% Cl 1.16-5.36) but not by patients without diabetes (ratio 0.91; 95% Cl 0.40.2.06). The number of nurse's appointments increased for patients without diabetes (ratio 1.31; 95% Cl 1.07-1.60) but not for those with diabetes (ratio 1.04; 95% Cl 0.88-1.24). CONCLUSIONS: Patients with diabetes visit more often physicians and nurses compared with those without diabetes. During a 1-year follow-up, the use of community hospital care increased significantly among patients with diabetes. In addition to focusing on prevention and care of diabetes, these results suggest the importance of diabetes in planning community-based health care services.

Incidence of muscle relaxant use in relation to diagnosis of Parkinson's disease.

Background Parkinson's disease is the second most common neurodegenerative disorder. Motor and non-motor symptoms seem to precede the diagnosis of Parkinson's disease. Objective To evaluate the incidence of muscle relaxant use in community-dwelling persons with and without Parkinson's disease from 4 years before to 4 years after the diagnosis of Parkinson's disease. Method Nationwide register-based cohort included all community-dwelling Finnish persons who received reimbursement of Parkinson's disease drugs between 2000 and 2015 (N = 17,450) and comparison persons without Parkinson's disease who were matched for age, gender and region of residence (N = 122,694). Data on muscle relaxant use during 1995-2016 were collected from the Prescription Register. Results The incidence of muscle relaxant use was higher among persons with Parkinson's disease in comparison to persons without Parkinson's disease from 3 years before the diagnosis until 6 months after the diagnosis. The largest difference in incidence rates was observed at the time of the diagnosis (incidence rate ratio = 2.04, 95% confidence interval = 1.81-2.30). Tizanidine was the most frequently initiated muscle relaxant. Conclusions The incidence of muscle relaxant use starts increasing years before the diagnosis of Parkinson's disease but declines after that. It is important to identify the causes of muscle symptoms to avoid unnecessary muscle relaxant use and consequent adverse effects and events.