Evaluation of no-show rate in outpatient clinics with open access scheduling system: A systematic review.

Background: Patients' missed appointments can cause interference in the functions of the clinics and the visit of other patients. One of the most effective strategies to solve the problem of no-show rate is the use of an open access scheduling system (OA). This systematic review was conducted with the aim of investigating the impact of OA on the rate of no-show of patients in outpatient clinics. Methods: Relevant articles in English were investigated based on the keywords in title and abstract using PubMed, Scopus, and Web of Science databases and Google Scholar search engine (July 23, 2023). The articles using OA and reporting the no-show rate were included. Exclusion criteria were as follows: (1) review articles, opinion, and letters, (2) inpatient scheduling system articles, and (3) modeling or simulating OA articles. Data were extracted from the selected articles about such issues as study design, outcome measures, interventions, results, and quality score. Findings: From a total of 23,403 studies, 16 articles were selected. The specialized fields included family medicine (62.5%, 10), pediatrics (25%, four), ophthalmology, podiatric, geriatrics, internal medicine, and primary care (6.25%, one). Of 16 articles, 10 papers (62.5%) showed a significant decrease in the no-show rate. In four articles (25%), the no-show rate was not significantly reduced. In two papers (12.5%), there were no significant changes. Conclusions: According to this study results, it seems that in most outpatient clinics, the use of OA by considering some conditions such as conducting needs assessment and system design based on the patients' and providers' actual needs, and cooperating of all system stakeholders through consistent training caused a significant decrease in the no-show rate.

Effect of an Online Appointment Scheduling System on Evaluation Metrics of Outpatient Scheduling System: a before-after MulticenterStudy.

Online appointment scheduling systems have been designed in response to the problems of the traditional ones. In Iran, most outpatient clinics and our study population suffer from high patient' no-show rate and long waiting times because of not using online appointment scheduling system. In this study, the effect of an online appointment scheduling system was investigated by comparing the evaluation metrics of appointment scheduling before and after the intervention. This before-after pilot study was conducted on ten outpatient clinics with different specializations. Five clinics were selected as the intervention group and five clinics as the control group. A checklist was designed to evaluate appointment scheduling metrics. These checklists were completed from April to July 2017 in the pre-implementation phase and from September to December 2017 in the post-implementation phase. The evaluation metrics were evaluated before and after the implementation of the online appointment scheduling system. A total of 470 checklists containing 9034 patients' information and 460 checklists containing 9130 patients' information were completed at the pre- and post-implementation phases, respectively. There were significant positive effect on the improvement of the three metrics means, including Patient waiting time (38.2 min before vs. 23.8 min after the intervention), No-show rate (25% before vs. 11% after the intervention), and Physician punctuality (-30 min before vs. -14.2 min after the intervention). The use of an online appointment scheduling system was successful in improving several evaluation metrics in our target population and resulted in continued usage in intervention group clinics.

Design and Evaluation of a Smart Medication Recommendation System for the Electronic Prescription.

BACKGROUND: electronic prescription is shown to have many benefits in terms of reducing medication errors, improving patient safety, productivity, and resource management, but it may cause new errors and physician frustration if not designed and implemented properly. Improving usability and user-centered design is essential for physicians' adoption. OBJECTIVES: To enhance the efficiency of the e-prescribing system by reducing the risk of inappropriate selection of the medication and also to reduce the prescribing time and effort to reach the desired drug. METHODS: Important data fields for predicting medications were determined through interviews with pharmacists. Among those, fields which were available in a claims dataset of 16 million prescriptions were extracted and were used to develop a neural network model to be used by a recommender system that displays the most probable medications on top of the drop-down list in the e-prescription application. RESULTS: Offline and field evaluations both showed that this model could improve performance. CONCLUSION: smart recommenders systems can improve e-prescription usability, safety, and enhanced physicians' adoption.

Evaluation of patient satisfaction of the status of appointment scheduling systems in outpatient clinics: Identifying patients' needs.

Appointment scheduling systems are potentially useful tools for enhancing the patient satisfaction. This study was conducted to inspect patient's needs and satisfaction of the current status of appointment scheduling systems in outpatient clinics. This cross-sectional study was conducted in 10 outpatient clinics with different specializations. The outpatient clinics were selected based on the stratified randomization method. Data were collected using a questionnaire from December 2016 to March 2017. The questionnaire reliability was measured with the participation of 15 patients using the test-retest method. The content validity was also evaluated by 13 experts. A total of 319 patients completed the survey. The mean score of overall patient satisfaction and the patient satisfaction of the clinic environment were 6.73 ± 0.16 and 8.30 ± 0.12, respectively. The average waiting time was 64.2 ± 3.45 min. The service time took on an average 9.85 ± 0.37 min. The patient satisfaction of the clinic environment (P = 0.023), length of waiting time (P = 0.001), and duration of service time (P = 0.005) had a statistically significant association with overall patient satisfaction. Based on the results, the need for improving overall patient satisfaction score was felt. The patient satisfaction of waiting time, service time, and clinic environment had the greatest influence on overall patient satisfaction. Furthermore, it is recommended that a web-based appointment scheduling system should be implemented.

A survey of attitudes, practices, and knowledge regarding drug-drug interactions among medical residents in Iran.

Background When prescribing medications, physicians should recognize clinically relevant potential drug-drug interactions (DDIs). To improve medication safety, it is important to understand prescribers' knowledge and opinions pertaining to DDIs. Objective To determine the current DDI information sources used by medical residents, their knowledge of DDIs, their opinions about performance feedback on co-prescription of interacting drugs. Setting Academic hospitals of Mashhad University of Medical Sciences (MUMS) in Iran. Methods A questionnaire containing questions regarding demographic and practice characteristics, DDI information sources, ability to recognize DDIs, and opinions about performance feedback was distributed to medical residents of 22 specialties in eight academic hospitals in Iran. We analyzed their perception pertaining to DDIs, their performance on classifying drug pairs, and we used a linear regression model to assess the association of potential determinants on their DDI knowledge. Main Outcome Measure prescribers' knowledge and opinions pertaining to DDIs. Results The overall response rate and completion rate for 315 distributed questionnaires were 90% (n = 295) and 86% (n = 281), respectively. Among DDI information sources, books, software on mobile phone or tablet, and Internet were the most commonly-used references. Residents could correctly classify only 41% (5.7/14) of the drug pairs. The regression model showed no significant association between residents' characteristics and their DDI knowledge. An overwhelming majority of the respondents (n = 268, 95.4%) wished to receive performance feedback on co-prescription of interacting drugs in their prescriptions. They mostly selected information technology-based tools (i.e. short text message and email) as their preferred method of receiving feedback. Conclusion Our findings indicate that prescribers may have poor ability to prevent clinically relevant potential DDI occurrence, and they perceive the need for performance feedback. These findings underline the importance of well-designed computerized alerting systems and delivering performance feedback to improve patient safety.

Information Technology-Based Interventions to Improve Drug-Drug Interaction Outcomes: A Systematic Review on Features and Effects.

The purpose of this systematic review was to identify features and effects of information technology (IT)-based interventions on outcomes related to drug-drug interactions (DDI outcomes). A literature search was conducted in Medline, EMBASE, and the Cochrane Library for published English-language studies. Studies were included if a main outcome was related to DDIs, the intervention involved an IT-based system, and the study design was experimental or observational with controls. Study characteristics, including features and effects of IT-based interventions, were extracted. Nineteen studies comprising five randomized controlled trials (RCT), five non-randomized controlled trials (NRCT) and nine observational studies with controls (OWC) were included. Sixty-four percent of prescriber-directed interventions, and all non-prescriber interventions, were effective. Each of the following characteristics corresponded to groups of studies of which a majority were effective: automatic provision of recommendations within the providers' workflow, intervention at the time of decision-making, integration into other systems, and requiring the reason for not following the recommendations. Only two studies measured clinical outcomes: an RCT that showed no significant improvement and an OWC that showed improvement, but did not statistically assess the effect. Most studies that measured surrogate outcomes (e.g. potential DDIs) and other outcomes (e.g. adherence to alerts) showed improvements. IT-based interventions improve surrogate clinical outcomes and adherence to DDI alerts. However, there is lack of robust evidence about their effectiveness on clinical outcomes. It is recommended that researchers consider the identified features of effective interventions in the design of interventions and evaluate the effectiveness on DDI outcomes, particularly clinical outcomes.

Incidence rate and pattern of clinically relevant potential drug-drug interactions in a large outpatient population of a developing country.

The objective of this study was to determine incidence rate, type, and pattern of clinically relevant potential drug-drug interactions (pDDIs) in a large outpatient population of a developing country. A retrospective, descriptive cross-sectional study was conducted on outpatients' prescriptions in Khorasan Razavi province, Iran, over 12 months. A list of 25 clinically relevant DDIs, which are likely to occur in the outpatient setting, was used as the reference. Most frequent clinically relevant pDDIs, most common drugs contributing to the pDDIs, and the pattern of pDDIs for each medical specialty were determined. Descriptive statistics were used to report the results. In total, out of 8,169,142 prescriptions, 6,096 clinically relevant pDDIs were identified. The most common identified pDDIs were theophyllines-quinolones, warfarin-nonsteroidal anti-inflammatory drugs, benzodiazepines-azole antifungal agents, and anticoagulants-thyroid hormones. The most common drugs contributing to the identified pDDIs were ciprofloxacin, theophylline, warfarin, aminophylline, alprazolam, levothyroxine, and selegiline. While the incidence rate of clinically relevant pDDIs in prescriptions of general practitioners, internists, and cardiologists was the highest, the average pDDI incidence per 10,000 prescriptions of pulmonologists, infectious disease specialists, and cardiologists was highest. Although a small proportion of the analyzed prescriptions contained drug pairs with potential for clinically relevant DDIs, a significant number of outpatients have been exposed to the adverse effects associated with these interactions. It is recommended that in addition to training physicians and pharmacists, other effective interventions such as computerized alerting systems and electronic prescribing systems be designed and implemented.

Drug-drug interactions in inpatient and outpatient settings in Iran: a systematic review of the literature.

Drug-drug interactions (DDIs) are an important type of adverse drug events. Yet overall incidence and pattern of DDIs in Iran has not been well documented and little information is available about the strategies that have been used for their prevention. The purpose of this study was to systematically review the literature on the incidence and pattern of DDIs in Iran as well as the used strategies for their prevention. PubMed, Scopus, electronic Persian databases, and Google Scholar were searched to identify published studies on DDIs in Iran. Additionally, the reference lists of all retrieved articles were reviewed to identify additional relevant articles. Eligible studies were those that analyzed original data on the incidence of DDIs in inpatient or outpatient settings in Iran. Articles about one specific DDI and drug interactions with herbs, diseases, and nutrients were excluded. The quality of included studies was assessed using quality assessment criteria. Database searches yielded 1053 potentially eligible citations. After removing duplicates, screening titles and abstracts, and reading full texts, 34 articles were found to be relevant. The quality assessment of the included studies showed a relatively poor quality. In terms of study setting, 18 and 16 studies have been conducted in inpatient and outpatient settings, respectively. All studies focused on potential DDIs while no study assessed actual DDIs. The median incidence of potential DDIs in outpatient settings was 8.5% per prescription while it was 19.2% in inpatient settings. The most indicated factor influencing DDIs incidence was patient age. The most involved drug classes in DDIs were beta blockers, angiotensin-converting-enzyme inhibitors (ACEIs), diuretic agents, and non-steroidal anti-inflammatory drugs (NSAIDs). Thirty-one studies were observational and three were experimental in which the strategies to reduce DDIs were applied. Although almost all studies concluded that the incidence of potential DDIs in Iran in both inpatient and outpatient settings was relatively high, there is still no evidence of the incidence of actual DDIs. More extensive research is needed to identify and minimize factors associated with incidence of DDIs, and to evaluate the effects of preventive interventions especially those that utilize information technology.

Usability evaluation of Laboratory and Radiology Information Systems integrated into a hospital information system.

This study was conducted to evaluate the usability of widely used laboratory and radiology information systems. Three usability experts independently evaluated the user interfaces of Laboratory and Radiology Information Systems using heuristic evaluation method. They applied Nielsen's heuristics to identify and classify usability problems and Nielsen's severity rating to judge their severity. Overall, 116 unique heuristic violations were identified as usability problems. In terms of severity, 67 % of problems were rated as major and catastrophic. Among 10 heuristics, "consistency and standards" was violated most frequently. Moreover, mean severity of problems concerning "error prevention" and "help and documentation" heuristics was higher than of the others. Despite widespread use of specific healthcare information systems, they suffer from usability problems. Improving the usability of systems by following existing design standards and principles from the early phased of system development life cycle is recommended. Especially, it is recommended that the designers design systems that inhibit the initiation of erroneous actions and provide sufficient guidance to users.