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2.
Int J Comput Assist Radiol Surg ; 14(5): 861-871, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30887422

RESUMO

PURPOSE: For the parallel external fixator, there are some defects, such as uneven distraction rate, unbearable pain and uncontrollable movement trajectory in practical clinical applications. In order to solve the problems, a new deformity correction algorithm, which is used to calculate the elongation of the six struts, is developed. Meanwhile, the corresponding computer software for getting the electronic prescription is developed. METHODS: First, the trajectory of the moving bone is planned by Cartesian coordinate path control. Next, the prescription is obtained from the trajectory by the inverse pose solution algorithm. Finally, the genetic algorithm is utilized to optimize the achieved prescription. From the year of 2015 to 2018, twenty-three patients with complicated tibia deformity are treated by using parallel external fixator and the developed computer software. All patients have standing, patella-forward, full-length post-operative AP and lateral radiographs of the lower limbs with the complete proximal ring for getting the deformity parameters and frame parameters. These parameters are input into the computer software to calculate a daily prescription schedule for strut adjustment. Radiographs are taken regularly to determine the effects of recovery during the correction process. RESULTS: The mean time of follow-up is 18 months (range 11-40 months). All patients reach the requirements for deformity correction, and their symptoms and appearance are improved significantly. No cases of wound infections or complications occur, and no severe pain came as well during the correction process. CONCLUSIONS: By using the computer-aided parallel external fixator for the correction of lower limb deformities, satisfactory outcomes can be achieved. Hence, this method greatly improved the treatment of these patients in a clinical application.


Assuntos
Algoritmos , Prescrição Eletrônica/normas , Fixadores Externos , Fêmur/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Procedimentos Ortopédicos/métodos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Fêmur/anormalidades , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Desigualdade de Membros Inferiores/diagnóstico , Masculino , Pessoa de Meia-Idade , Radiografia , Software , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
3.
Int J Med Inform ; 123: 49-53, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30654903

RESUMO

INTRODUCTION: Outpatient Electronic Prescription Systems (OEPSs) are widely used in some European states, such as Denmark, Sweden and the Netherlands. The Czech OEPS (known as eRecept) was introduced in 2011, but with limited functions and voluntary usage it was not much accepted until 2018, when its usage was made compulsory not only for pharmacies, but for physicians as well. METHODS: Using data from the Czech State Institute for Drug Control (Státní ústav pro kontrolu léciv or SÚKL in Czech) and from other sources, the system was described and data about its performance since 2013 have been obtained. RESULTS: The usage of the system was very low between 2013 and 2016, whilst moderate growth was seen in 2017. By 2018, the system has been widely adopted, although some twenty per cent of Czech physicians still do not use the system at all. DISCUSSION: A sudden rise in usage can be explained as the result of making the system compulsory starting in January 2018. Still, new features of the system are eagerly awaited and should be introduced to expand its benefits. CONCLUSION: The Czech Republic has joined the EU countries widely using the OEPS.


Assuntos
Prescrição Eletrônica/normas , Erros de Medicação/prevenção & controle , Pacientes Ambulatoriais/estatística & dados numéricos , República Tcheca , Humanos
4.
Int J Clin Pharm ; 41(1): 228-236, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30446896

RESUMO

Background The computerization of prescriptions with a computerized physician order entry contributes to securing the error-free drug supply, but is not risk-free. Objective: To determine the impact of a computerized physician order entry system on prescribing errors immediately after its implementation and 1 year later. Setting The Cardiology and Diabetology Departments at Toulouse University Hospital, France. Method The prescriptions were analysed by pharmacists over three 30-day periods for 3 consecutive years (N: computerization period, N - 1, N + 1). For each identified error, the prescriber was informed by a pharmaceutical intervention. The pharmaceutical interventions were counted and arranged according to the classification by the French Society of Clinical Pharmacy. Their average numbers and clinical impacts were compared for each period using t-tests and Kruskal-Wallis tests. Main outcome measure The average numbers of pharmaceutical interventions. Results In total, 12.1 pharmaceutical interventions per 100 patient days were done during the N - 1 period, 14.1 during N and 9.6 during N + 1. Among those, 3.6 (N) and 2.1 (N + 1) were related to the computerization itself, and 10.5 (N) and 7.5 (N + 1) were not. The average number of computerization-related pharmaceutical interventions significantly decreased from N to N + 1 (p = 0.04). The average number of classic interventions decreased from N - 1 to N + 1 (p = 0.02). The clinical impacts of the computerization related errors were similar to those of other errors. Conclusion The implementation of the computerized physician order entry induced the appearance of specific computerized-related errors, but the number of classic errors decreased. The entry-system related errors were not more severe than other errors, and the number decreased after 1 year.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Reconciliação de Medicamentos/normas , Feminino , Humanos , Masculino , Reconciliação de Medicamentos/métodos , Farmacêuticos/normas , Médicos/normas , Estudos Retrospectivos
5.
Health Aff (Millwood) ; 37(11): 1877-1883, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30395495

RESUMO

While electronic prescribing has been shown to reduce medication errors and improve prescribing safety, it is vulnerable to error-prone processes. We review six intersecting areas in which changes to electronic prescribing systems, particularly in the outpatient setting, could transform medication ordering quality and safety. We recommend incorporating medication indications into electronic prescribing, establishing a single shared online medication list, implementing the transmission of electronic cancellation orders to pharmacies (CancelRx) to ensure that drugs are safely and reliably discontinued, implementing standardized structured and codified prescription instructions, reengineering clinical decision support, and redesigning electronic prescribing to facilitate the ordering of nondrug alternatives.


Assuntos
Prescrições de Medicamentos , Prescrição Eletrônica/normas , Sistemas de Registro de Ordens Médicas/normas , Erros de Medicação/prevenção & controle , Humanos , Pacientes Ambulatoriais , Farmácias
6.
J Patient Saf ; 14(4): 241-245, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30451716

RESUMO

OBJECTIVES: Compared with blank prescriptions, electronic prescribing (e-prescribing) is safer and more formulary-compliant, satisfying, and efficient. Owing to cost, fewer publicly funded organizations use e-prescribing but may afford preformatted prescription forms. We investigated whether preformatted prescription forms confer similar benefits as e-prescribing. METHODS: Two preformatted prescription forms containing medications' name, strength, dose, route, frequency, number of refills, and restrictions were released in an adult medicine clinic, which previously used blank forms. Pharmacy data were evaluated for changes in prescribing safety and formulary compliance. Surveys assessed changes in prescribing satisfaction and perceived efficiency. RESULTS: Preformatted prescription forms yielded safer, more formulary-compliant prescribing than blank forms. Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for prescribing errors compared with the same medications prescribed previously using blank forms (54% vs. 31%, P = 0.014). Among medications preformatted on forms, a smaller percentage of pharmacy interventions were for formulary noncompliance compared with the same medications prescribed previously using blank forms (21% vs. 4%, P = 0.002).Nearly all respondents felt preformatted forms helped with legibility and choosing the correct dose and proper strength. Fifty percent of respondents indicated the forms improved medication selection.Preformatted forms were perceived as more satisfying and efficient. Ninety-three percent of respondents stated they would use the forms on their next patient. CONCLUSIONS: Preformatted prescription forms achieved the major objectives of e-prescribing: safer, more formulary-compliant, satisfying, and efficient prescribing. They can serve as a transitional phase to e-prescribing for resource-constrained organizations such as publicly funded clinics.


Assuntos
Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Assistência Farmacêutica/normas , Adulto , Humanos
7.
Int J Med Inform ; 119: 88-93, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30342691

RESUMO

CONTEXT: Despite widespread efforts to improve the quality and safety of healthcare through use of hospital information systems (HIS), many healthcare organizations face challenges in implementation and effective use of these applications, in particular when systems have been developed internationally (mainly in the US). Suppliers of these technologies also find it challenging to produce systems that work effectively across a range of geographical, cultural and institutional boundaries. In this paper, we seek to understand the strategies used by suppliers and adopters of HIS to overcome the challenges involved in the development and adoption of generic overseas systems. METHODS: We conducted a qualitative study, by interviewing 176 individuals (eight organizations), observing two user groups, and running a supplier focus group. We used inductive thematic analysis to assess emerging strategies in developing and implementing overseas packaged HIS in English settings. FINDINGS: The health sector in England has entered a period of potentially transformative change with many international HIS suppliers entering the market. This has provoked call for the 'Anglicization' of generic systems. This endeavor, has resulted in emergence of more or less aligned supplier and user strategies to overcome the difficulties in the process. This includes a continuous process of identification and classification of requests (by suppliers), and unification and voicing of needs (by adopters). CONCLUSIONS: The complexity of health service provision, drives calls for customization of technologies in this sector. Consequent tensions between 'standardization' and 'localization' are requiring suppliers of generic solutions to develop more sophisticated strategies as they pursue international growth of their market.


Assuntos
Comportamento de Escolha , Coleta de Dados/métodos , Prescrição Eletrônica/normas , Sistemas de Informação Hospitalar/normas , Pesquisa Qualitativa , Inglaterra , Humanos
8.
J Gen Intern Med ; 33(12): 2070-2077, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30076573

RESUMO

BACKGROUND: Oral anticoagulants reduce the risk of stroke in patients with atrial fibrillation. However, many patients with atrial fibrillation at elevated stroke risk are not treated with oral anticoagulants. OBJECTIVE: To test whether electronic notifications sent to primary care physicians increase the proportion of ambulatory patients prescribed oral anticoagulants. DESIGN: Randomized controlled trial conducted from February to May 2017 within 18 practices in an academic primary care network. PARTICIPANTS: Primary care physicians (n = 175) and their patients with atrial fibrillation, at elevated stroke risk, and not prescribed oral anticoagulants. INTERVENTION: Patients of each physician were randomized to the notification or usual care arm. Physicians received baseline email notifications and up to three reminders with patient information, educational material and primary care guidelines for anticoagulation management, and surveys in the notification arm. MAIN MEASURES: The primary outcome was the proportion of patients prescribed oral anticoagulants at 3 months in the notification (n = 972) vs. usual care (n = 1364) arms, compared using logistic regression with clustering by physician. Secondary measures included survey-based physician assessment of reasons why patients were not prescribed oral anticoagulants and how primary care physicians might be influenced by the notification. KEY RESULTS: Over 3 months, a small proportion of patients were newly prescribed oral anticoagulants with no significant difference in the notification (3.9%, 95% CI 2.8-5.3%) and usual care (3.2%, 95% CI 2.4-4.2%) arms (p = 0.37). The most common, non-exclusive reasons why patients were not on oral anticoagulants included atrial fibrillation was transient (30%) or paroxysmal (12%), patient/family declined (22%), high bleeding risk (20%), fall risk (19%), and frailty (10%). For 95% of patients, physicians stated they would not change their management after reviewing the alert. CONCLUSIONS: Electronic physician notification did not increase anticoagulation in patients with atrial fibrillation at elevated stroke risk. Primary care physicians did not prescribe anticoagulants because they perceived the bleeding risk was too high or stroke risk was too low. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02950285.


Assuntos
Anticoagulantes/administração & dosagem , Fibrilação Atrial/tratamento farmacológico , Prescrição Eletrônica/normas , Fidelidade a Diretrizes/normas , Sistemas de Registro de Ordens Médicas/normas , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/epidemiologia , Feminino , Humanos , Masculino
9.
J Clin Psychopharmacol ; 38(5): 447-453, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30113352

RESUMO

BACKGROUND: Patients with severe mental illness are at risk of medical complications, including cardiovascular disease, metabolic syndrome, and diabetes. Given this vulnerability, combined with metabolic risks of antipsychotics, physical health monitoring is critical. Inpatient admission is an opportunity to screen for medical comorbidities. Our objective was to improve the rates of physical health monitoring on an inpatient psychiatry unit through implementation of an electronic standardized order set. METHODS: Using a clinical audit tool, we completed a baseline retrospective audit (96 eligible charts) of patients aged 18 to 100 years, discharged between January and March 2012, prescribed an antipsychotic for 3 or more days. We then developed and implemented a standard electronic admission order set and provided training to inpatient clinical staff. We completed a second chart audit of patients discharged between January and March 2016 (190 eligible charts) to measure improvement in physical health monitoring and intervention rates for abnormal results. RESULTS: In the 2012 audit, thyroid-stimulating hormone (TSH), blood pressure, blood glucose, fasting lipids, electrocardiogram (ECG), and height/weight were measured in 71%, 92%, 31%, 36%, 51%, and 75% of patients, respectively. In the 2016 audit, TSH, blood pressure, blood glucose, fasting lipids, ECG, and height/weight were measured in 86%, 96%, 96%, 64%, 87%, and 71% of patients, respectively. There were statistically significant improvements (P < 0.05) in monitoring rates for blood glucose, lipids, ECG, and TSH. Intervention rates for abnormal blood glucose and/or lipids (feedback to family doctor and/or patient, consultation to hospitalist, endocrinology, and/or dietician) did not change between 2012 and 2016. CONCLUSIONS: Electronic standardized order set can be used as a tool to improve screening for physical health comorbidity in patients with severe mental illness receiving antipsychotic medications.


Assuntos
Prescrição Eletrônica/normas , Nível de Saúde , Pacientes Internados/psicologia , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Monitorização Fisiológica/normas , Adulto , Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Glicemia/efeitos dos fármacos , Glicemia/metabolismo , Eletrocardiografia/efeitos dos fármacos , Eletrocardiografia/normas , Feminino , Humanos , Masculino , Transtornos Mentais/diagnóstico , Saúde Mental , Pessoa de Meia-Idade , Monitorização Fisiológica/tendências , Estudos Retrospectivos
10.
Br J Nurs ; 27(15): 869-875, 2018 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-30089040

RESUMO

The wearing of compression garments is an essential aspect of the management of lymphoedema. Patients however, do not always receive the requested garment on an NHS prescription from their general practitioner (GP). Through an audit cycle over 3 years, necessary changes in clinical practice were identified and introduced. The aim was to improve the number of patients obtaining the correct garment on an NHS prescription. The audit standard was not met in any of the audits and the conclusion made is that compression garments are difficult to find on NHS electronic prescribing systems leading to a delay in patients receiving their prescription and a risk of error due to the wide range of options available. Further work is necessary to ensure that electronic prescribing systems address the problem of product recognition for compression garments so that the process of obtaining compression garments is smooth, accurate and timely for patients and their GPs.


Assuntos
Bandagens Compressivas , Prescrição Eletrônica/normas , Linfedema/terapia , Auditoria Clínica , Vestuário , Humanos
12.
Pharmacoepidemiol Drug Saf ; 27(10): 1101-1111, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29687504

RESUMO

PURPOSE: To assess the accuracy of using diagnostic codes from administrative data to infer treatment indications for antidepressants prescribed in primary care. METHODS: Validation study of administrative diagnostic codes for 13 plausible indications for antidepressants compared with physician-documented treatment indications from an indication-based electronic prescribing system in Quebec, Canada. The analysis included all antidepressant prescriptions written by primary care physicians between January 1, 2003 and December 31, 2012 using the electronic prescribing system. Patient prescribed antidepressants were linked to physician claims and hospitalization data to obtain all diagnoses recorded in the past year. RESULTS: Diagnostic codes had poor sensitivity for all treatment indications, ranging from a high of only 31.2% (95% CI, 26.8%-35.9%) for anxiety/stress disorders to as low as 1.3% (95% CI, 0.0%-5.2%) for sexual dysfunction. Sensitivity was notably worse among older patients and patients with more chronic comorbidities. Physician claims data were a better source of diagnostic codes for antidepressant treatment indications than hospitalization data. CONCLUSIONS: Administrative diagnostic codes are poor proxies for antidepressant treatment indications. Future work should determine whether the use of other variables in administrative data besides diagnostic codes can improve the ability to predict antidepressant treatment indications.


Assuntos
Antidepressivos/uso terapêutico , Análise de Dados , Depressão/classificação , Depressão/tratamento farmacológico , Prescrição Eletrônica/normas , Classificação Internacional de Doenças/normas , Adulto , Idoso , Depressão/epidemiologia , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Quebeque/epidemiologia , Reprodutibilidade dos Testes
13.
Diabetes Metab Syndr ; 12(5): 635-641, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29666033

RESUMO

AIM: The primary aim of this study was to examine the prescribing patterns of antidiabetic agents (AA) in this hospital according to current prescribing contraindications (PCI). The secondary aims are to assess factors affecting the prescribing of AA and to evaluate the pharmacist impact on their prescribing. METHOD: A retrospective cross sectional study was performed to review all prescribed AA over a 3 month period. Data extracted from medical records included: patients' demographics, management and pharmacists' interventions. Appropriateness of prescribing was determined according to the AA prescribing information of the Medical Index of Medical Specialities (MIMS). RESULTS: A total of 314 AA were examined, of which 74(23%) orders were prescribed despite contraindications. Metformin was the AA to have the most PCI in dosage adjustments in renal impairment (RI). Logistic regression analysis showed patients with severe RI were less likely to be prescribed metformin (OR = 0.115 95%CI(0.048-0.274) P < 0.01), instead insulin was preferred (OR = 2.210 95%CI (1.028-4.751) P < 0.05). Insulin was also more likely to be prescribed in patients with hypertension and hyperglycaemia (OR=2.005 95%CI(1.005-4.001) P < 0.05, OR = 3.535 95%CI(1.756-7.113) P < 0.01) respectively. Sulphonylureas were less likely to be prescribed in patients with cardiovascular disease (OR = 0.339 95%CI(0.163-0.708), P < 0.01. There was low PCI in the other AA. Pharmacists reviewed 89% of AA. PCI was lower in this group compared to those with no pharmacist input (23% vs 28%). CONCLUSION: The audit showed good adherence to PCI. Pharmacist involvement has a positive impact on AP. Prescriber education is required in relation to dosage adjustments of AA in RI.


Assuntos
Diabetes Mellitus Tipo 2/tratamento farmacológico , Prescrições de Medicamentos/normas , Prescrição Eletrônica/normas , Fidelidade a Diretrizes/normas , Hipoglicemiantes/uso terapêutico , Guias de Prática Clínica como Assunto/normas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Farmacêuticos/normas , Serviço de Farmácia Hospitalar/métodos , Serviço de Farmácia Hospitalar/normas , Estudos Retrospectivos
14.
Am J Health Syst Pharm ; 75(5): 321-326, 2018 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-29472515

RESUMO

PURPOSE: The implementation of a chronic pain protocol (CPP) and its effects on the management of long-term opioid therapy are described. SUMMARY: The CPP used at a federally qualified health center and primary care clinic was updated in 2015 and included a prescribing ceiling in morphine equivalent dose (MED) per day and standardized the prescribing of chronic opioids. Intermittent urine drug screening performed at least once annually was added as a requirement of the pain management contract between the provider and the patient. An electronic report was developed to identify patients who were receiving long-term opioid therapy at the clinic. The clinical pharmacists identified patients from the report whose long-term opioid doses were over the clinic-recommended MED threshold, needed a pain contract, or were due for a urine drug screen. The number of patients for whom long-term opioids were prescribed decreased for all clinicians, including an 88% reduction by nurse practitioners. Over 12 months, 97 fewer patients with chronic pain were treated with a long-term opioid at the clinic. The number of patients with pain contracts increased by 22.9% (p < 0.001), and the number of patients who had a urine drug screen over a 12-month period increased by 18.3% (p = 0.0016). CONCLUSION: The implementation of a CPP and the development of electronic reports to track provider adherence to the protocol led to a reduction in the number of chronic pain patients receiving long-term opioid therapy. The number of patients with pain contracts increased.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Prescrição Eletrônica/normas , Sistemas de Registro de Ordens Médicas/normas , Manejo da Dor/normas , Dor Crônica/diagnóstico , Feminino , Humanos , Masculino , Sistemas de Registro de Ordens Médicas/tendências , Manejo da Dor/tendências
15.
J Med Internet Res ; 20(2): e68, 2018 02 23.
Artigo em Inglês | MEDLINE | ID: mdl-29475826

RESUMO

BACKGROUND: One of the forerunners in electronic health, Finland has introduced electronic prescriptions (ePrescriptions) nationwide by law. This has led to significant changes for pharmacy customers. Despite the worldwide ambition to develop ePrescription services, there are few reports of nationally adopted systems and particularly on the experiences of pharmacy customers. OBJECTIVE: The aim of this study was to investigate Finnish pharmacy customers' (1) experiences with purchasing medicines with ePrescriptions; (2) experiences with renewing ePrescriptions and acting on behalf of someone else at the pharmacy; (3) ways in which customers keep up to date with their ePrescriptions; and (4) overall satisfaction with ePrescriptions. METHODS: Questionnaires were distributed to 2913 pharmacy customers aged ≥18 years purchasing prescription medicines for themselves with an ePrescription in 18 community pharmacies across Finland in autumn 2015. Customers' experiences were explored with 10 structured questions. The data were stored in SPSS for Windows and subjected to descriptive analysis, chi-square, Fisher exact, Kolmogorov-Smirnov, the Mann-Whitney U, and Kruskal-Wallis tests. RESULTS: Completed questionnaires were returned by 1288 customers, a response rate of 44.19% (1288/2913). The majority of the respondents did not encounter any problems during pharmacy visits (1161/1278, 90.85%) and were informed about the current status of their ePrescriptions after their medication was dispensed (1013/1276, 79.44%). Over half of the respondents had usually received a patient instruction sheet from their physician (752/1255, 59.92%), and nearly all of them regarded its content as clear (711/724, 98.2%). Half of the respondents had renewed their ePrescriptions through the pharmacy (645/1281, 50.35%), and one-third of them had acted on behalf of someone else with ePrescriptions (432/1280, 33.75%). Problems were rarely encountered in the renewal process (49/628, 7.8%) or when acting on behalf of another person (25/418, 6.0%) at the pharmacy. The most common way of keeping up to date with ePrescriptions was to ask at the pharmacy (631/1278, 49.37%). The vast majority of the respondents were satisfied with ePrescriptions as a whole (1221/1274, 95.84%). CONCLUSIONS: Finnish pharmacy customers are satisfied with the recently implemented nationwide ePrescription system. They seldom have any difficulties purchasing medicines, renewing their ePrescriptions, or acting on behalf of someone else at the pharmacy. Customers usually keep up to date with their ePrescriptions by asking at the pharmacy. However, some customers are unaware of the practices or have difficulty keeping up to date with the status of their ePrescriptions. The provision of relevant information and assistance by health care professionals is therefore required to promote customers' adoption of the ePrescription system.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Prescrição Eletrônica/normas , Farmácias/normas , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
17.
Sultan Qaboos Univ Med J ; 18(4): e476-e482, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30988966

RESUMO

Objectives: This study aimed to evaluate physicians' perceptions of electronic prescribing in Kuwaiti primary healthcare centres. Methods: This cross-sectional study was conducted between June and August 2017 among 368 physicians from 25 primary healthcare centres in Kuwait. Data were collected from the participants using a self-reported questionnaire, including sociodemographic characteristics, previous experience with computers and awareness, knowledge and use of e-prescribing systems and their functional features. In addition, perceptions of the benefits and levels of satisfaction associated with e-prescribing were explored. Results: A total of 306 physicians completed the survey (response rate: 83%). The majority had positive perceptions regarding the use of e-prescribing, particularly in terms of time-savings (86%), healthcare quality (84%), productivity (80%) and clinical workflow and efficiency (83%). However, many respondents indicated that e-prescribing systems required additional improvements in terms of functionality. Conclusion: Most physicians in primary healthcare centres in Kuwait recognised the importance of e-prescribing to improve the quality of patient care, streamline workflow, increase productivity and reduce medical errors. However, there is a need to improve the design and infrastructure of e-prescribing systems, which may aid in the adoption of such systems in Kuwait.


Assuntos
Prescrição Eletrônica/normas , Percepção , Médicos/psicologia , Adulto , Estudos Transversais , Prescrição Eletrônica/estatística & dados numéricos , Feminino , Humanos , Kuweit , Masculino , Erros Médicos/prevenção & controle , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/tendências , Inquéritos e Questionários
18.
Pharm. care Esp ; 20(4): 247-268, 2018. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176662

RESUMO

Introducción: Los pacientes rechazan la dispensación de e-recetas disponibles sin que se pueda comprobar si ello implica incumplimiento terapéutico. La no adherencia limita la efectividad de los tratamientos farmacológicos. Objetivos: Evaluar en una farmacia comunitaria la prevalencia del rechazo de prescripciones disponibles en receta electrónica, los motivos de no retirada, la percepción de los pacientes sobre su tratamiento y la posible relación de estos factores con la falta de adherencia terapéutica. Material y métodos: Estudio observacional transversal realizado en noviembre-diciembre de 2017. Se cuantificó la disponibilidad, retirada y no retirada de e-recetas y los motivos referidos. A una muestra de pacientes se realizó el test de Morisky-Green-Levine para evaluar el cumplimiento. Resultados: De 1341 e-recetas disponibles, el 29,6% no fue retirado, siendo el incumplimiento o su sospecha y la posología variable los motivos más frecuentes. Los pensionistas rechazan significativamente más que los activos. En la segunda fase resultó un incumplimiento del 48,5%. No se encontró relación entre no retirada e incumplimiento, aunque el 58,3% de incumplidores no había retirado todas las e-recetas disponibles. Sin relación con sexo, edad, nivel de estudios, condición laboral y número de e-recetas. El 20,2% tiene percepción negativa de su medicación con relación significativa con el incumplimiento. Conclusiones: Pese a no haberse encontrado relación significativa entre incumplimiento y no retirada de todas las e-recetas, este hecho puede utilizarse como indicador de dificultades en la utilización de los medicamentos para ofrecer al paciente acciones de educación para la salud y seguimiento farmacoterapéutico que mejoren el cumplimiento


Background: Patients reject the dispensing of available electronic prescriptions without being able to verify if this implies therapeutic non-compliante. Non-adherence to treatments is a major social problem, which limits effectiveness of them. Objectives: To assess the prevalence of non-dispensation of electronic prescriptions and its possible implications on pharmacotherapeutic non-compliance. Methods: A transversal and observational study conducted during November-December of 2017. Availability, aceptance and rejection of electronic prescriptions were quantified and the reasons of rejections were noted. Morisky-Green-Levine test was applied to a sample of patients in order to determine compliance. Results: Out of 1341 e-prescriptions available, 29.6% were rejections. The most frequent reason was the non-compliance or its suspicion and a variable posology. Pensioners reject significantly more than the actives ones. Genitourinary, musculoskeletal and respiratory are the groups with the highest percentage of rejections. In the second phase, a 48.5% non-compliance resulted. No relationship was found between rejection and non-compliance, although 58.3% of non-compliers had not acepted all available electronic prescriptions. No relation either to sex, age, educational level, employment status and number of electronic prescriptions available. 20.2% have a negative perception of their medication with significant relation to the non-compliance. Conclusions: Despite not having found a significant relationship between non-compliance and rejection of all electronic prescriptions, this fact could be used as an indicator of difficulties in the use of medicines. This would help pharmacist to apply health education actions and to develop pharmacotherapeutic follow-up programs that could improve compliance


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adesão à Medicação , Recusa do Paciente ao Tratamento , Farmácias/organização & administração , Prescrição Eletrônica/estatística & dados numéricos , Estudo Observacional , Estudos Transversais , Boas Práticas de Dispensação , Intervalos de Confiança , Inquéritos e Questionários , Prescrição Eletrônica/normas , Quimioterapia Assistida por Computador
19.
Emergencias (St. Vicenç dels Horts) ; 29(6): 384-390, dic. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-168509

RESUMO

Objetivo. Estudiar la frecuencia y el perfil de los pacientes ingresados que tienen mayor riesgo de errores de conciliación (EC) y si las prescripciones originadas por los médicos de urgencias (MU), mediante una herramienta de prescripción electrónica de texto libre, presentan más EC que las realizadas por los médicos responsables de la planta de hospitalización (MPH) con un programa de prescripción electrónica asistida. Método. Estudio de una serie de casos prospectivos con análisis transversal que incluyo por oportunidad a los pacientes ingresados en plantas de hospitalización convencional de los servicios de medicina interna, geriatría y oncología durante un periodo de 6 meses. Los EC detectados por un farmacéutico se analizaron en función de los factores de riesgo teóricos y del responsable de la prescripción (MU frente a MPH). Resultados. Se incluyeron 148 pacientes, 68 (45,9%) con prescripción de los MU y 80 (54,1%) de los MPH. El farmacéutico detecto 303 EC y 113 pacientes (76,4%) presentaron al menos un EC. No hubo diferencias significativas según el responsable de la prescripción conciliada. Los EC se asociaron a la polimedicación [OR 3,4 (IC 95%:1,2-9,0; p = 0,016)] y el tener pluripatología en el grupo de pacientes menores de 80 anos [OR 3,9 (IC95%:1,1-14,7; pinteracción = 0,039)]. Conclusiones. La frecuencia de EC es elevada indistintamente de si el responsable de la prescripción fue el MU o el MPH. Los pacientes con mayor riesgo de EC fueron los polimedicados y los menores de 80 años con pluripatología (AU)


Objectives. To study the frequency of medication reconciliation errors (MREs) in hospitalized patients and explore the profiles of patients at greater risk. To compare the rates of errors in prescriptions written by emergency physicians and ward physicians, who each used a different prescribing tool. Methods. Prospective cross-sectional study of a convenience sample of patients admitted to medical, geriatric, and oncology wards over a period of 6 months. A pharmacist undertook the medication reconciliation report, and data were analyzed for possible associations with risk factors or prescriber type (emergency vs ward physician). Results. A total of 148 patients were studied. Emergency physicians had prescribed for 68 (45.9%) and ward physicians for 80 (54.1%). A total of 303 MREs were detected; 113 (76.4%) patients had at least 1 error. No statistically significant differences were found between prescriber types. Factors that conferred risk for a medication error were use polypharmacy (odds ratio [OR], 3.4; 95% CI, 1.2-9.0; P=.016) and multiple chronic conditions in patients under the age of 80 years (OR, 3.9; 95% CI, 1.1-14.7; P=.039). Conclusion. The incidence of MREs is high regardless of whether the prescriber is an emergency or ward physician. The patients who are most at risk are those taking several medications and those under the age of 80 years who have multiple chronic conditions (AU)


Assuntos
Humanos , Reconciliação de Medicamentos/organização & administração , Erros de Medicação/prevenção & controle , Prescrições de Medicamentos/normas , Segurança do Paciente , Polimedicação , Fatores de Risco , Comorbidade , Prescrição Eletrônica/estatística & dados numéricos , Prescrição Eletrônica/normas , Estudos Prospectivos , Modelos Logísticos
20.
J Manag Care Spec Pharm ; 23(11): 1130-1139, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-29083967

RESUMO

BACKGROUND: Little research has been conducted on the quality, benefits, costs, and financial considerations associated with health information technology (HIT), particularly informatics technologies such as e-prescribing, from the perspective of all of its stakeholders. OBJECTIVES: To (a) identify the stakeholders involved in e-prescribing and (b) identify and rank order the positives and negatives of e-prescribing from the perspective of stakeholders in order to create a framework for payers, integrated delivery systems, policymakers and legislators, and those who influence public policy to assist them in the development of incentives and payment mechanisms that result in the better management of care. METHODS: The Delphi method was used to enlist a panel of experts in e-prescribing, informatics, and/or HIT who have published in the field. This panel was presented with the results of initial research and an online survey of questions that sought to prioritize the quality, benefit, cost, and financial effects of e-prescribing from the perspective of each stakeholder. Eleven experts completed the first survey, which contained a list of stakeholders and positives and negatives associated with e-prescribing. Nine of the 11 experts completed the second survey, and 7 experts completed the final survey. From the results of these 3 surveys, a framework was presented to 5 framework experts, who were representatives from payers, integrated delivery systems, policymakers and legislators, and those who influence public policy. These framework experts were interviewed regarding the usefulness of the framework from their perspectives. RESULTS: The experts added stakeholders and many positives and negatives to the initial list and rank ordered the positives and negatives of e-prescribing from the perspective of each stakeholder. The aggregate results were summarized by stakeholder category. The positives and negatives were categorized as health, finance, effort, time, management, or data concerns. The framework experts evaluated the framework and found it useful. CONCLUSIONS: Positives and negatives associated with e-prescribing in the areas of quality, benefits, costs, and financial considerations can be rank ordered from the perspective of each stakeholder. The experts agreed on some points but disagreed on others. For example, they agreed that the main negative of e-prescribing from the perspective of pharmacists and pharmacies was its implementation costs but differed on the importance of providing faster information transfer. A framework was created that could be successfully used by payers, integrated delivery systems, policymakers and legislators, and those who influence public policy for the development of incentives and payment mechanisms. DISCLOSURES: This research was supported by the National Library of Medicine of the National Institutes of Health under Award Number T15LM007088. The authors declare no conflicts of interest in the research. Study concept and design were contributed by DeMuro, Ash, Middleton, and Fletcher. DeMuro took the lead in data collection, along with Ash, and data interpretation was performed by DeMuro, Ash, Madison, Middleton, and Fletcher. The manuscript was written primarily by DeMuro, along with Ash and Middleton, and revised by DeMuro, Madison, and Ash, along with Middleton and Fletcher.


Assuntos
Técnica Delfos , Prescrição Eletrônica/normas , Informática Médica/normas , Motivação , Assistência ao Paciente/normas , Participação dos Interessados , Prescrição Eletrônica/economia , Humanos , Informática Médica/economia , Assistência ao Paciente/economia
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