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- Hammar, Tora, 1984-, et al.
(författare)
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Potential drug-related problems detected by electronic expert support system : physicians’ views on clinical relevance
- 2015
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Ingår i: International Journal of Clinical Pharmacy. - : Springer Science and Business Media LLC. - 2210-7703 .- 2210-7711. ; 37:5, s. 941-948
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Tidskriftsartikel (refereegranskat)abstract
- Background Drug-related problems cause suffering for patients and substantial costs. Multi-dose drug dispensing is a service in which patients receive their medication packed in bags with one unit for each dose occasion. The electronic expert support system (EES) is a clinical decision support system that provides alerts if potential drug-related problems are detected among a patients’ current prescriptions, including drug–drug interactions, therapy duplications, high doses, drug-disease interactions, drug gender warnings, and inappropriate drugs and doses for geriatric or pediatric patients. Objective The aim of the study was to explore physicians’ views on the clinical relevance of alerts provided by EES. Furthermore we investigated if physicians performed any changes in drug treatment following the alerts and if there were any differences in perceived relevance and performed changes between different types of alerts and drugs. Setting Two geriatric clinics and three primary care units in Sweden. Method Prescribed medications for patients (n = 254) with multi-dose drug dispensing were analyzed for potential drug-related problems using EES. For each alert, a physician assessed clinical relevance and indicated any intended action. A total of 15 physicians took part in the study. Changes in drug treatment following the alerts were later measured. The relationship between variables was analyzed using Chi square test. Main outcome measure Physicians’ perceived clinical relevance of each alert, and changes in drug treatment following the alerts. ResultsPhysicians perceived 68 % (502/740) of EES alerts as clinically relevant and 11 % of all alerts were followed by a change in drug treatment. Clinical relevance and likelihood to make changes in drug treatment was related to the alert category and substances involved in the alert. Conclusion In most patients with multi-dose drug dispensing, EES detected potential drug-related problems, with the majority of the alerts regarded as clinically relevant and some followed by measurable changes in drug treatment.
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| 2. |
- Hammar, Tora, 1984-, et al.
(författare)
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Potential drug related problems detected by electronic expert support system in patients with multi-dose drug dispensing.
- 2014
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Ingår i: International Journal of Clinical Pharmacy. - : Springer. - 2210-7703 .- 2210-7711. ; 36:5, s. 943-952
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Tidskriftsartikel (refereegranskat)abstract
- Background Drug related problems (DRPs) are frequent and cause suffering for patients and substantial costs for society. Multi-dose drug dispensing (MDDD) is a service by which patients receive their medication packed in bags with one unit for each dose occasion. The clinical decision support system (CDSS) electronic expert support (EES) analyses patients’ prescriptions in the Swedish national e-prescription repository and provides alerts if potential DRPs are detected, i.e. drug–drug interactions, duplicate therapy, drug-disease contraindications, high dose, gender warnings, geriatric, and paediatric alerts. Objective To analyse potential DRPs in patients with MDDD, detected by means of EES. Setting A register study of all electronically stored prescriptions for patients with MDDD in Sweden (n = 180,059) March 5–June 5, 2013. Method Drug use and potential DRPs detected in the study population during the 3 month study period by EES were analysed. The potential DRPs were analysed in relation to patients’ age, gender, number of drugs, and type of medication. Main outcome measure Prevalence of potential DRPs measured as EES alerts. Results The study population was on average 75.8 years of age (±17.5, range 1–110) and had 10.0 different medications (±4.7, range 1–53). EES alerted for potential DRPs in 76 % of the population with a mean of 2.2 alerts per patient (±2.4, range 0–27). The older patients received a lower number of alerts compared to younger patients despite having a higher number of drugs. The most frequent alert categories were drug–drug interactions (37 % of all alerts), duplicate therapy (30 %), and geriatric warnings for high dose or inappropriate drugs (23 %). Psycholeptics, psychoanaleptics, antithrombotic agents, anti-epileptics, renin-angiotensin system agents, and analgesics represented 71 % of all drugs involved in alerts. Conclusions EES detected potential DRPs in the majority of patients with MDDD. The number of potential DRPs was associated with the number of drugs, age, gender, and type of medication. A CDSS such as EES might be a useful tool for physicians and pharmacists to assist in the important task of monitoring patients with MDDD for potential DRPs.
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| 3. |
- Hedström, Mariann, 1965-, et al.
(författare)
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PHASE-20 : Ett nytt instrument för skattning av möjliga läkemedelsrelaterade symtom hos äldre personer i äldreboende
- 2009
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Ingår i: Vård i Norden. - 0107-4083 .- 1890-4238. ; 29:4, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundElderly persons may easily develop adverse drug effects. In Sweden, at least seven untested instruments are used for assessing possible drug-related symptoms in elderly people.AimThe aim was to develop a more valid and reliable instrument for identification of possible therapeutic drug-related symptoms.Methods The seven pre-existing instruments consisted of 39 symptoms, which were coordinated and then analyzed for content validity. After revision, the instrument included 19 symptoms or symptom-groups and one open variable. To assess the construct validity and reliability, the new instrument, PHASE-20, was tested in a randomized controlled trial with elderly persons living in two nursing homes before and after evaluation and correction of their therapeutic drugs.Results PHASE-20 was found to possess an acceptable consistency, test-retest reliability, and internal validity. Construct validity was not supported in this study, as there were no significant differences between groups after the intervention. Therapeutic drug-related symptoms among elderly might be too heterogeneous to be captured into a screening instrument. However, PHASE-20 was welcomed by both patients and staff as a well structured, easily understandable, and useful assessment instrument.Conclusion PHASE-20 can be used for identifying possible drug-related symptoms among elderly who are able to cooperate at least partly.
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