A nationwide computerized patient medication history: evaluation of the Austrian pilot project "e-Medikation".

PURPOSE: To manage medication treatment and to assure medication safety, health care professionals need a complete overview of all drugs that have been prescribed or are taken by a patient. In 2009, Austria launched the pilot project "e-Medikation" in three pilot regions. E-Medikation gives access to a patient's nationwide medication list and includes medication safety checks. The objective of this paper is to report on the evaluation results and lessons learnt. METHODS: A formative evaluation study performed between July and December 2011 comprised a standardized survey of participating physicians, pharmacists, and patients, as well as an analysis of the e-Medikation log files. RESULTS: During the evaluation period, 18,310 prescriptions and 13,797 dispensings were documented, and 22,359 medication safety checks were performed. Overall, 61 physicians, 68 pharmacists, and 553 patients responded to a written survey. The results showed high acceptance of the idea of e-Medikation among pharmacists and patients and mixed acceptance among physicians. The satisfaction with the quality of the software used in the pilot project was low. CONCLUSIONS: The overall aim to increase medication safety seems achievable through e-Medikation, but several limitations of the pilot project need to be solved before a national rollout. Based on the evaluation results and after redesign of e-Medikation, Austria is now planning a nationwide introduction of e-Medikation starting in 2015.

The Austrian e-Medikation pilot evaluation: lessons learned from a national medication list.

The objective of this paper is to present results and recommendations from the Austrian e-Medikation pilot project. e-Medikation comprises a national medication list of all prescribed and dispensed medications as well as central medication checks. Evaluation was based on log-file analysis and survey of all participants (physicians, pharmacists, patients). During the evaluation period, 97 physicians, 58 pharmacies and more than 5.000 patients, participated. All user groups found that e-Medikation has the potential to improve patient safety, but that software quality and system architecture is not yet suitable for routine use. The evaluation resulted in 34 recommendations for further development and roll out of e-Medikation in Austria. Most of these recommendations have already been included in the recently passed law concerning the upcoming Austrian electronic health record system called "ELGA".

Prevalence of mild cognitive impairment subtypes in patients attending a memory outpatient clinic--comparison of two modes of mild cognitive impairment classification. Results of the Vienna Conversion to Dementia Study.

BACKGROUND: Early detection of dementia is becoming more and more important owing to the advent of pharmacologic treatment. OBJECTIVE: The goals of this study were to establish prevalence of mild cognitive impairment (MCI) subtypes in an outpatient memory clinic cohort using two different modes of MCI determination. DESIGN: Consecutive patients complaining of cognitive problems who came to the memory outpatient clinic for assessment of a possible cognitive disorder were included in the study. SETTING: Academic medical center. PARTICIPANTS: Six hundred eighty consecutive patients complaining about cognitive problems who came to the memory outpatient clinic for assessment of a possible cognitive disorder and fulfilled the inclusion criteria were included in the study. For 676 patients, sufficient data for MCI classification were available. RESULTS: Categorizing MCI patients into MCI subtypes according to the minimum mode of MCI classification revealed the following results: 106 patients (15.7%) were categorized as cognitively healthy, whereas 570 patients (84.3%) met the criteria for MCI. MCI patients were subtyped as amnestic mild cognitive impairment (aMCI) single domain (31 patients; 4.6%), aMCI multiple domain (226 patients; 33.4%), non-aMCI single domain (125 patients; 18.5%), and non-aMCI multiple domain (188 patients; 27.8%). Categorizing MCI patients into MCI subtypes according to the mean mode of MCI classification revealed the following results: 409 patients (60.5%) were categorized as cognitively healthy, whereas 267 patients (39.5%) met the criteria for MCI. MCI patients were subtyped as aMCI single domain (47 patients; 6.9%), aMCI multiple domain (57 patients; 8.5%), non-aMCI single domain (97 patients; 14.3%), and non-aMCI multiple domain (66 patients; 9.8%). CONCLUSION: MCI diagnosis frequencies are substantially affected by the criteria used for estimation of MCI. The effect of modifying the presence of impairment on a single cognitive measure versus the presence of impairment on a mean composite score of a certain domain differed considerably, ranging from 39.5% to 84.3%, indicating the importance of the development of guidelines for operationalizing MCI.