scholarly journals Type 1 medication review based on a pharmacy’s electronic medication records: first steps towards an algorithm to stratify patients for tailored pharmacy services

2021 ◽  
Vol 18 (1) ◽  
pp. 1-15
Author(s):  
Ligia Reis ◽  
Miguel Monteiro ◽  
Luis Lourenço ◽  
João Gregório
Keyword(s):  
Medication Review ◽  
Median Number ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Convenience Sample ◽  
Knowledge Based ◽  
Inappropriate Drugs ◽  
Medication Reviews ◽  
Definition Of

Algorithms, queries, and knowledge-based systems are among approaches to screen electronic patient records stored in databases and support pharmacist medication reviews. The aim of this study was to perform a type 1 medication review and identify clusters that enable the definition of an algorithm to tailor pharmacy professional interv A retrospective observational study was conducted on a convenience sample of pharmacy records. Records were included if patients had a medication dispensing history between June 2017 - July 2018 and used two or more chronic medications. Statistical analysis used a two-step cluster to identify common characteristics among fifty-five sets of patient records which underwent Type 1 medication review. The median number of drugs used per patient was five [IQR: 3.0 – 7.0]. 18.2% of patients had inappropriate drugs, and 30.9% had moderate or major interaction potential. Four clusters were identified based on the variables of interactions, number of drugs used, contraindications, Beers criteria and measurable biomarkers, allowing to envision possible pharmaceutical interventions, as well as the priority in providing that intervention. The identification of patient clusters via medication review of electronic records of pharmacy patients supports the design of criteria-based algorithms, likely to be automated.

Are we getting it right? A review of end-of-life care in community nursing

2021 ◽  
Vol 26 (7) ◽  
pp. 348-352
Author(s):  
Nicky Thorpe ◽  
Rachel Singh ◽  
Helen Chapman ◽  
Lisa Farndon
Keyword(s):  
End Of Life ◽  
Response Rate ◽  
Patient Records ◽  
Community Nursing ◽  
Electronic Patient Records ◽  
Convenience Sample ◽  
Nursing Service ◽  
E Learning ◽  
Community Trust ◽  
Eol Care

End-of-life (EoL) care is an important role in community nursing. In order to assess a community nursing team's performance in the delivery of EoL care, an evaluation of the EoL care template was undertaken from electronic patient records. Records were assessed against a set of four care priorities across 23 nursing teams in a large acute/community trust. Some 103 electronic patient records were evaluated out of a convenience sample of 110 (94% response rate). The results demonstrated that patients' wishes are being discussed and documented and the priorities of care are being considered with patients needing EoL care. Thus, patients and their families are being supported by the community nursing service, which is communicating with them sensitively and involving patients in the decision-making process. In some cases, the EoL Care Template was not fully completed, which would result in poorer communication across teams and organisations of practice within the wider community. Future action will be focused on continuing to encourage and improve the use of the EoL care template as well as the local online e-learning package for EoL care.

PP38 Rates of recording different aspects of patients’ social history on ambulance electronic patient records – a service evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A16.1-A16
Author(s):  
Chloé R Barley ◽  
Imogen M Gunson
Keyword(s):  
Social History ◽  
Median Number ◽  
Service Evaluation ◽  
Patient Records ◽  
Completion Rates ◽  
Electronic Patient Records ◽  
Minimal Impact ◽  
History Data ◽  
Qualitative Work ◽  
The Impact

BackgroundUnderstanding the impact of a patient’s social history forms part of medical assessments and wider NHS data collection. To date, there has been little work examining the extent of social history recording by ambulance clinicians. The aim of this service evaluation is to examine how frequently staff complete social history fields on electronic patient records and to identify patterns in completion rate when comparing categories of call, localities of crew, conveyance or non-conveyance, and individual fields of social history data.MethodA retrospective review of one NHS ambulance trust’s electronic patient records (attended 01/01/2019 – 31/12/2019) was conducted. 10% of the records were analysed due to software limitations (n = 134434 adult cases).ResultsVery few cases (<0.05%) had every field completed, with 28.6% of all cases having no fields completed at all. In 45% of cases, between 8 and 11 fields were completed. The mean number of fields completed per case was 5.79 and the median number was 7.‘Mobility’ and ‘Home circumstances’ were the most frequently completed and ‘Sexual Orientation’ and ‘Language’ were the least.Category of call appears to have minimal impact on completion rates. Localities and specialists had more variation, ranging from 21.3% to 49.9% with no fields completed at all.ConclusionSocial history documentation is very infrequently fully completed by frontline ambulance crews within this service. The majority of cases have a partially complete social history however, due to software limitations, it is unknown whether the same fields are consistently completed throughout these cases.Further research, including qualitative work, is recommended to understand the low rate of recording of social history data and how this information is used by ambulance staff.

Medication review by GPs reduces polypharmacy in the elderly: A quality use of medicines program

2004 ◽  
Vol 10 (1) ◽  
pp. 78 ◽  
Author(s):  
Patrick GM Bolton ◽  
Steven W Tipper ◽  
Judith L Tasker
Keyword(s):  
Medication Review ◽  
Selective Serotonin Reuptake Inhibitors ◽  
The Elderly ◽  
Median Number ◽  
Quality Assurance Program ◽  
Care Needs ◽  
Quality Use Of Medicines ◽  
Assisted Gps ◽  
Medication Reviews ◽  
Complex Care Needs

This paper describes a Quality Use of Medicines program, addressing polypharmacy in the elderly through a quality assurance program that assisted GPs to improve their prescribing through medication reviews. Sixty-two GPs from four Divisions of General Practice each enrolled up to 12 of their patients aged over 65 for medication review. Data about the total number of medications, and number and dosage of selected cardiovascular and psychotropic medications taken by these patients, were collected. A statistically significant reduction in the total number of medications (p < 0.00005), and the dose (p = 0.028) and number (p = 0.0077) of benzodiazepines, and an increase in the number of Selective Serotonin Reuptake Inhibitors (SSRI) antidepressants (p = 0.0075) were observed. We conclude that these results suggest that medication review by GPs on patients who have complex care needs can be associated with a reduction in the median number of medications that these patients take.

Electronic Patient Records in Medical Practice: A Multidisciplinary Endeavor

1999 ◽  
Vol 38 (04/05) ◽  
pp. 287-288 ◽  
Author(s):  
J. van der Lei ◽  
P. W. Moorman ◽  
M. A. Musen
Keyword(s):  
Medical Practice ◽  
Patient Records ◽  
Electronic Patient Records

Postmarketing Surveillance Based on Electronic Patient Records: The IPCI Project

1999 ◽  
Vol 38 (04/05) ◽  
pp. 339-344 ◽  
Author(s):  
J. van der Lei ◽  
B. M. Th. Mosseveld ◽  
M. A. M. van Wijk ◽  
P. D. van der Linden ◽  
M. C. J. M. Sturkenboom ◽  
...  
Keyword(s):  
General Practitioner ◽  
General Practitioners ◽  
Validation Studies ◽  
Resource Planning ◽  
Routine Practice ◽  
Patient Records ◽  
Postmarketing Surveillance ◽  
Electronic Patient Records ◽  
Use Of Data ◽  
Data Requirements

AbstractResearchers claim that data in electronic patient records can be used for a variety of purposes including individual patient care, management, and resource planning for scientific research. Our objective in the project Integrated Primary Care Information (IPCI) was to assess whether the electronic patient records of Dutch general practitioners contain sufficient data to perform studies in the area of postmarketing surveillance studies. We determined the data requirements for postmarketing surveil-lance studies, implemented additional software in the electronic patient records of the general practitioner, developed an organization to monitor the use of data, and performed validation studies to test the quality of the data. Analysis of the data requirements showed that additional software had to be installed to collect data that is not recorded in routine practice. To avoid having to obtain informed consent from each enrolled patient, we developed IPCI as a semianonymous system: both patients and participating general practitioners are anonymous for the researchers. Under specific circumstances, the researcher can contact indirectly (through a trusted third party) the physician that made the data available. Only the treating general practitioner is able to decode the identity of his patients. A Board of Supervisors predominantly consisting of participating general practitioners monitors the use of data. Validation studies show the data can be used for postmarketing surveillance. With additional software to collect data not normally recorded in routine practice, data from electronic patient record of general practitioners can be used for postmarketing surveillance.

scholarly journals Electronic patient record and its effects on social aspects of interprofessional collaboration and clinical workflows in hospitals (eCoCo): a mixed methods study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Marina Beckmann ◽  
Kerstin Dittmer ◽  
Julia Jaschke ◽  
Ute Karbach ◽  
Juliane Köberlein-Neu ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Health Services ◽  
Healthcare Professionals ◽  
Social Research ◽  
Interprofessional Collaboration ◽  
Participant Observation ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Daily Work ◽  
Network Analyses

Abstract Background The need for and usage of electronic patient records within hospitals has steadily increased over the last decade for economic reasons as well as the proceeding digitalization. While there are numerous benefits from this system, the potential risks of using electronic patient records for hospitals, patients and healthcare professionals must also be discussed. There is a lack in research, particularly regarding effects on healthcare professionals and their daily work in health services. The study eCoCo aims to gain insight into changes in interprofessional collaboration and clinical workflows resulting from introducing electronic patient records. Methods eCoCo is a multi-center case study integrating mixed methods from qualitative and quantitative social research. The case studies include three hospitals that undergo the process of introducing electronic patient records. Data are collected before and after the introduction of electronic patient records using participant observation, interviews, focus groups, time measurement, patient and employee questionnaires and a questionnaire to measure the level of digitalization. Furthermore, documents (patient records) as well as structural and administrative data are gathered. To analyze the interprofessional collaboration qualitative network analyses, reconstructive-hermeneutic analyses and document analyses are conducted. The workflow analyses, patient and employee assessment analyses and classification within the clinical adoption meta-model are conducted to provide insights into clinical workflows. Discussion This study will be the first to investigate the effects of introducing electronic patient records on interprofessional collaboration and clinical workflows from the perspective of healthcare professionals. Thereby, it will consider patients’ safety, legal and ethical concerns and quality of care. The results will help to understand the organization and thereby improve the performance of health services working with electronic patient records. Trial registration The study was registered at the German clinical trials register (DRKS00023343, Pre-Results) on November 17, 2020.

scholarly journals What makes digital health intrusive? Qualitative findings from an international study on diabetes

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
T Oikonomidi ◽  
P Ravaud ◽  
A James ◽  
E Cosson ◽  
V Montori ◽  
...  
Keyword(s):  
Private Sector ◽  
Health Care Professionals ◽  
Online Survey ◽  
Dietary Habits ◽  
Digital Health ◽  
Treatment Burden ◽  
Convenience Sample ◽  
Digital Monitoring ◽  
Food Monitoring

Abstract Background Remote digital monitoring (RDM, i.e., using digital devices to monitor patients' health and behavior) is a novel care model that can improve health outcomes for people with chronic conditions. However, it could be intrusive to patients' lives. We sought to understand which aspects of RDM make it intrusive to patients and why. Methods We performed content analysis of qualitative data collected by using open-ended questions in an international, online survey with a convenience sample of adults with type 1 or 2 diabetes (February-July 2019). Participants were first shown scenarios describing possible RDM features (i.e. different RDM tools [for glucose or food monitoring], feedback loops [receiving feedback in consultation, or remotely by a physician, or by artificial intelligence], and data handling options [by the public or private sector]). Results We analyzed data from 709 participants from 24 countries (38% men, median age 38, 54% type 1). Participants found RDM burdensome (n = 468). Burden arose from RDM features that caused disruption in daily life (e.g., alerts), features that may invite undesirable attention in public (e.g., visible wearable sensors may invite questions about one's health), or from having to adapt one's life to fit in RDM (e.g., adapt one's mealtime routine around food monitoring). Participants wanted control, particularly over sharing food-monitoring data with health care professionals in real-time to receive feedback (n = 440). They felt RDM could expose a delicate topic to 'surveillance' by authority figures (i.e., their data may 'reveal' poor dietary habits, leading to criticism by physicians). Intrusion could take the form of RDM eroding the patient-physician relationship (n = 34), or fear of data misuse (n = 206), which was associated with private-sector financial interests. Conclusions Our findings offer directions for minimally intrusive RDM design and show that digital health may cause concerns about stigma and treatment burden. Key messages Remote digital monitoring is intrusive when it increases treatment burden and limits patients’ control over their own health. “Minimally intrusive” digital health design could increase patient acceptability and, ultimately, foster scalability.

scholarly journals Using electronic patient records to assess the effect of a complex antenatal intervention in a cluster randomised controlled trial—data management experience from the DESiGN Trial team

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sophie Relph ◽  
◽  
Maria Elstad ◽  
Bolaji Coker ◽  
Matias C. Vieira ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Data Quality ◽  
Data Management ◽  
Randomised Control Trial ◽  
Data Dictionary ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Cluster Randomised ◽  
Quality Checks ◽  
Data Harmonisation

Abstract Background The use of electronic patient records for assessing outcomes in clinical trials is a methodological strategy intended to drive faster and more cost-efficient acquisition of results. The aim of this manuscript was to outline the data collection and management considerations of a maternity and perinatal clinical trial using data from electronic patient records, exemplifying the DESiGN Trial as a case study. Methods The DESiGN Trial is a cluster randomised control trial assessing the effect of a complex intervention versus standard care for identifying small for gestational age foetuses. Data on maternal/perinatal characteristics and outcomes including infants admitted to neonatal care, parameters from foetal ultrasound and details of hospital activity for health-economic evaluation were collected at two time points from four types of electronic patient records held in 22 different electronic record systems at the 13 research clusters. Data were pseudonymised on site using a bespoke Microsoft Excel macro and securely transferred to the central data store. Data quality checks were undertaken. Rules for data harmonisation of the raw data were developed and a data dictionary produced, along with rules and assumptions for data linkage of the datasets. The dictionary included descriptions of the rationale and assumptions for data harmonisation and quality checks. Results Data were collected on 182,052 babies from 178,350 pregnancies in 165,397 unique women. Data availability and completeness varied across research sites; each of eight variables which were key to calculation of the primary outcome were completely missing in median 3 (range 1–4) clusters at the time of the first data download. This improved by the second data download following clarification of instructions to the research sites (each of the eight key variables were completely missing in median 1 (range 0–1) cluster at the second time point). Common data management challenges were harmonising a single variable from multiple sources and categorising free-text data, solutions were developed for this trial. Conclusions Conduct of clinical trials which use electronic patient records for the assessment of outcomes can be time and cost-effective but still requires appropriate time and resources to maximise data quality. A difficulty for pregnancy and perinatal research in the UK is the wide variety of different systems used to collect patient data across maternity units. In this manuscript, we describe how we managed this and provide a detailed data dictionary covering the harmonisation of variable names and values that will be helpful for other researchers working with these data. Trial registration Primary registry and trial identifying number: ISRCTN 67698474. Registered on 02/11/16.

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