scholarly journals 147. Pharmacist Attitudes Towards Using Clinical Decision Support in Community Pharmacies to Promote Antibiotic Stewardship in the Treatment of Uncomplicated UTI

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S84-S84
Author(s):  
Sena Sayood ◽  
Katie Suda ◽  
Michael Durkin
Keyword(s):  
Decision Support ◽  
Community Pharmacy ◽  
Clinical Decision Support ◽  
Community Pharmacists ◽  
Clinical Decision ◽  
Community Pharmacies ◽  
Uncomplicated Urinary Tract Infection ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
Pharmacist Attitudes

Abstract Background Prior studies of prescribing practices have shown that providers frequently choose non-guideline concordant treatment regimens to treat uncomplicated urinary tract infection (UTI). It has also been shown that uncomplicated UTI can be treated safely, and in a guideline concordant manner, by non-physician providers using an algorithm over the phone. The purpose of this study was to assess pharmacist attitudes towards using a clinical decision support (CDS) tool that would be used to evaluate and manage patients presenting with complaints of UTI in the community pharmacy setting. Methods We conducted semi-structured interviews of community pharmacists (n = 21) from 2019 to 2020 until thematic saturation was reached. Pharmacists were questioned about their attitudes towards stewardship, workflow, interactions with patients and providers, and interest in using a computerized CDS tool. Interviews were recorded, transcribed, and de-identified. Coding and analysis of the interviews was performed using NVivo version 12. Results Pharmacists were interviewed with practice experience ranging from 2 to 54 years (median 13, IQR 6, 27). All pharmacists expressed interest in using CDS to assist with patient evaluations and stewardship. They reported that patients routinely use the community pharmacy as a first stop for medical advice and that they have several interactions per day with patients in which they counsel them on a variety of issues, including UTI. Their assessment and management decisions of UTIs were based on personal knowledge and not on any standard of care. Communication difficulties with primary care offices often delayed management of these patients and lack of information sharing made it difficult for pharmacists to engage in stewardship practices. Conclusion Community pharmacies are an important point of contact for patients and represent a significant opportunity to implement outpatient stewardship interventions. Pharmacists had an overwhelmingly favorable response to the prospect of using a CDS tool, both to help in patient evaluation and to promote antimicrobial stewardship. Based on these results we can conclude that it would be feasible to pilot a CDS tool in community pharmacies to further evaluate its safety and efficacy in the treatment of UTI. Disclosures All Authors: No reported disclosures

scholarly journals The use of a clinical decision support tool to assess the risk of QT drug–drug interactions in community pharmacies

2021 ◽  
Vol 12 ◽  
pp. 204209862199609
Author(s):  
Florine A. Berger ◽  
Heleen van der Sijs ◽  
Teun van Gelder ◽  
Patricia M. L. A. van den Bemt
Keyword(s):  
Decision Support ◽  
Drug Interactions ◽  
Clinical Decision Support ◽  
Decision Support Tool ◽  
Clinical Decision ◽  
Community Pharmacies ◽  
Support Tool ◽  
Interacting Agents ◽  
Before And After ◽  
Structured Approach

Introduction: The handling of drug–drug interactions regarding QTc-prolongation (QT-DDIs) is not well defined. A clinical decision support (CDS) tool will support risk management of QT-DDIs. Therefore, we studied the effect of a CDS tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. Methods: An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of three months were included. The impact of the use of a CDS tool to support the handling of QT-DDIs was studied. For each QT-DDI, handling of the QT-DDI and patient characteristics were extracted from the pharmacy information system. Primary outcome was the proportion of QT-DDIs with an intervention. Secondary outcomes were the type of interventions and the time associated with handling QT-DDIs. Logistic regression analysis was used to analyse the primary outcome. Results: Two hundred and forty-four QT-DDIs pre-CDS tool and 157 QT-DDIs post-CDS tool were included. Pharmacists intervened in 43.0% and 35.7% of the QT-DDIs pre- and post-CDS tool respectively (odds ratio 0.74; 95% confidence interval 0.49–1.11). Substitution of interacting agents was the most frequent intervention. Pharmacists spent 20.8 ± 3.5 min (mean ± SD) on handling QT-DDIs pre-CDS tool, which was reduced to 14.9 ± 2.4 min (mean ± SD) post-CDS tool. Of these, 4.5 ± 0.7 min (mean ± SD) were spent on the CDS tool. Conclusion: The CDS tool might be a first step to developing a tool to manage QT-DDIs via a structured approach. Improvement of the tool is needed in order to increase its diagnostic value and reduce redundant QT-DDI alerts. Plain Language Summary The use of a tool to support the handling of QTc-prolonging drug interactions in community pharmacies Introduction: Several drugs have the ability to cause heart rhythm disturbances as a rare side effect. This rhythm disturbance is called QTc-interval prolongation. It may result in cardiac arrest. For health care professionals, such as physicians and pharmacists, it is difficult to decide whether or not it is safe to proceed treating a patient with combinations of two or more of these QT-prolonging drugs. Recently, a tool was developed that supports the risk management of these QT drug–drug interactions (QT-DDIs). Methods: In this study, we studied the effect of this tool on the proportion of QT-DDIs for which an intervention was considered by pharmacists. An intervention study was performed using a pre- and post-design in 20 community pharmacies in The Netherlands. All QT-DDIs that occurred during a before- and after-period of 3 months were included. Results: Two hundred and forty-four QT-DDIs pre-implementation of the tool and 157 QT-DDIs post-implementation of the tool were included. Pharmacists intervened in 43.0% of the QT-DDIs before the tool was implemented and in 35.7% after implementation of the tool. Substitution of one of the interacting agents was the most frequent intervention. Pharmacists spent less time on handling QT-DDIs when the tool was used. Conclusion: The clinical decision support tool might be a first step to developing a tool to manage QT-DDIs via a structured approach.

scholarly journals Reducing Inappropriate Drug Use in Older Patients by Use of Clinical Decision Support in Community Pharmacy: A Mixed-Methods Evaluation

Drugs & Aging ◽  
2019 ◽  
Vol 37 (2) ◽  
pp. 115-123 ◽  
Author(s):  
Linda G. M. Mulder-Wildemors ◽  
Mette Heringa ◽  
Annemieke Floor-Schreudering ◽  
Paul A. F. Jansen ◽  
Marcel L. Bouvy
Keyword(s):  
Decision Support ◽  
Mixed Methods ◽  
Drug Use ◽  
Community Pharmacy ◽  
Clinical Decision Support ◽  
Older Patients ◽  
Clinical Decision ◽  
Inappropriate Drug ◽  
Mixed Methods Evaluation ◽  
Inappropriate Drug Use

scholarly journals Pharmacist-Initiated Pre-Emptive Pharmacogenetic Panel Testing with Clinical Decision Support in Primary Care: Record of PGx Results and Real-World Impact

Genes ◽  
2019 ◽  
Vol 10 (6) ◽  
pp. 416 ◽  
Author(s):  
Cathelijne H. van der Wouden ◽  
Paul C. D. Bank ◽  
Kübra Özokcu ◽  
Jesse J. Swen ◽  
Henk-Jan Guchelaar
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Clinical Decision Support ◽  
Real World ◽  
Community Pharmacists ◽  
Gene Interaction ◽  
Clinical Decision ◽  
Panel Testing ◽  
Primary Care Record ◽  
Primary Care Patients

Logistics and (cost-)effectiveness of pharmacogenetic (PGx)-testing may be optimized when delivered through a pre-emptive panel-based approach, within a clinical decision support system (CDSS). Here, clinical recommendations are automatically deployed by the CDSS when a drug-gene interaction (DGI) is encountered. However, this requires record of PGx-panel results in the electronic medical record (EMR). Several studies indicate promising clinical utility of panel-based PGx-testing in polypharmacy and psychiatry, but is undetermined in primary care. Therefore, we aim to quantify both the feasibility and the real-world impact of this approach in primary care. Within a prospective pilot study, community pharmacists were provided the opportunity to request a panel of eight pharmacogenes to guide drug dispensing within a CDSS for 200 primary care patients. In this side-study, this cohort was cross-sectionally followed-up after a mean of 2.5-years. PGx-panel results were successfully recorded in 96% and 68% of pharmacist and general practitioner (GP) EMRs, respectively. This enabled 97% of patients to (re)use PGx-panel results for at least one, and 33% for up to four newly initiated prescriptions with possible DGIs. A total of 24.2% of these prescriptions had actionable DGIs, requiring pharmacotherapy adjustment. Healthcare utilization seemed not to vary among those who did and did not encounter a DGI. Pre-emptive panel-based PGx-testing is feasible and real-world impact is substantial in primary care.

Non-user physician perspectives about an oncology clinical decision-support system: A qualitative study.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e14061-e14061
Author(s):  
Hermano Alexandre Lima Rocha ◽  
Srinivas Emani ◽  
Carlos Andre Moura Arruda ◽  
Rubina Rizvi ◽  
Pamela Garabedian ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Social Contexts ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Extensive Experience

e14061 Background: Advances in artificial intelligence (AI) continue to expand capabilities within the healthcare domain, particularly in the discipline of oncology. Watson For Oncology (WfO) is an AI-enabled clinical decision support system that presents potential therapeutic options for cancer-treating physicians. The objectives of this study were to identify non-user physicians’ expectations, perceived challenges and benefits of WfO use in Brazil. Methods: The study took place at Instituto do Câncer do Ceará (ICC), a Brazilian oncology hospital that implemented WfO in December 2017, but not all physicians adopted the tool. Physicians who had not used WfO (n = 5) were recruited through purposive sampling identified with the assistance of local research personnel. Semi-structured interviews were conducted in Portuguese and later de-identified and transcribed into English. A thematic analysis of interview data based on grounded theory by two members of the research team with extensive experience in qualitative data analysis was conducted. Results: Non-user physicians had positive perceptions about WfO, along with several concerns and uncertainties. They expected that WfO would be easy to learn, useful, and helpful. Physicians perceived that WfO would provide a more standardized approach to treatment than care without it. They also believed that WfO would play a supportive and not a substitute role in care especially for complex cases in which the physicians had more in-depth knowledge of a patient and already had an established patient-provider relationship. Physicians did expect WfO use to negatively impact productivity, specifically through longer office times per patient because of the need to enter data and review recommendations. Physicians questioned whether the use of WfO would negatively impact their autonomy and role in providing care. Finally, physicians also questioned whether the treatment suggested by WfO would fit the social context of a low-middle income country such as Brazil with limited technological and economic resources. Conclusions: The implementation of US-developed AI technologies, such as WfO, should be further explored in different social and economic contexts. Physician concerns about productivity and autonomy need to be assessed and addressed in AI implementation; one strategy is to leverage previous lessons learned from electronic health record (EHR) implementations. This study is a critical step in understanding potential user perspectives in adopting a new AI tool in different social contexts.

scholarly journals Understanding implementation and usefulness of electronic clinical decision support (eCDS) for melanoma in English primary care: a qualitative investigation

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101635 ◽  
Author(s):  
Merel M Pannebakker ◽  
Katie Mills ◽  
Margaret Johnson ◽  
Jon D Emery ◽  
Fiona M Walter
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Routine Practice ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Face To Face ◽  
Telephone Interviews ◽  
Pigmented Lesions ◽  
Electronic Clinical Decision Support

BackgroundTimely diagnosis of the serious skin cancer melanoma can improve patient outcomes. Clinical guidelines suggest that GPs use checklists, such as the 7-point checklist (7PCL), to assess pigmented lesions. In 2016, the 7PCL was disseminated by EMIS as an electronic clinical decision support (eCDS) tool.AimTo understand GP and patient perspectives on the implementation and usefulness of the eCDS.Design & settingSemi-structured interviews with GPs and patients were undertaken. The interviews took place in four general practices in the south east of England following consultations using the eCDS for suspicious pigmented lesions.MethodData were collected from semi-structured face-to-face interviews with GPs and from telephone interviews with patients. They were recorded and transcribed verbatim. The Consolidated Framework for Implementation Research (CFIR) underpinned the analysis using thematic approaches.ResultsA total of 14 interviews with GPs and 14 interviews with patients were undertaken. Most GPs reported that, as the eCDS was embedded in the medical record, it was useful, easy to use, time-efficient, and could facilitate patient–GP communication. They were less clear that it could meet policy or patient needs to improve early diagnosis, and some felt that it could lead to unnecessary referrals. Few felt that it had been sufficiently implemented at practice level. More felt confident with their own management of moles, and that the eCDS could be most useful for borderline decision-making. No patients were aware that the eCDS had been used during their consultation.ConclusionSuccessful implementation of a new tool, such as eCDS for melanoma, requires GPs to perceive its value and understand how it can best be integrated into clinical practice. Disseminating a tool without such explanations is unlikely to promote its adoption into routine practice.

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