scholarly journals Can a Hybrid Decision Support System Effectively Rule Out Prescriptions from Medication Review in Daily Practice? A Randomized Case-Control Study.

2021 ◽  
Author(s):  
Clara Levivien ◽  
Pauline Cavagna ◽  
Annick Grah ◽  
Romain Courseau ◽  
Yvonnick Bézie ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Medication Errors ◽  
Support System ◽  
Medication Review ◽  
Case Control Study ◽  
Daily Practice ◽  
Case Control ◽  
Control Study ◽  
Rule Out

Abstract Background Medication review is time-consuming and not exhaustive in most French hospitals. We routinely use an innovative hybrid decision support system using Artificial Intelligence to prioritize medication review by scoring prescriptions by their risk of containing at least one medication error.Aim We aimed to demonstrate the digital tool’s ability to improve prescription safety by ruling out prescriptions that are effectively risk-free in daily practice.Methods We conducted a case-control study to compare the rate of pharmaceutical interventions (PI) between low and high-risk prescriptions defined by the tool’s calculated score. Medication orders were reviewed daily by a clinical pharmacist. Proportion of prescriptions with at least one severe medication error was calculated in both groups. Severe medication errors were characterized through a multidisciplinary approach.Results Four hundred and twenty (107 low score and 313 high score) prescriptions were analyzed. A significant difference in the percentage of PI was found between the “low score” (29%) and “high score” (51%) prescriptions (p < 0.001). The percentage of prescriptions with severe medication errors was dramatically decreased in low score prescriptions (2.8% vs. 15,3% respectively; p < 0.05). During the study period, the use of this tool allowed to rule out 55% of all prescriptions in our hospital.Conclusion This new decision support tool is an accurate method to rule out “low score” prescriptions, with an acceptable risk of missing medication errors and can be improved by the integration of future features. It offers a solution to focus pharmaceutical expertise on the most at-risk prescriptions and considerably improve the safety of patients’ care.

scholarly journals Correction to: Implementation of the goal-directed medication review electronic decision support system (G-MEDSS)© into home medicines review: a protocol for a clusterrandomised clinical trial in older adults

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lisa Kouladjian O’Donnell ◽  
Mouna Sawan ◽  
Emily Reeve ◽  
Danijela Gnjidic ◽  
Timothy F. Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Clinical Trial ◽  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Medication Review ◽  
Electronic Decision Support ◽  
Electronic Decision Support System ◽  
Home Medicines Review

An amendment to this paper has been published and can be accessed via the original article.

scholarly journals Quality of Life and Anxious-depressive Symptoms in Cancer Patients Undergoing Mindfulness-based Interventions: Feasibility and Preliminary Outcomes on Prospective Single-centre Case-control Study (MIND4ME St.)

2017 ◽  
Vol 41 (S1) ◽  
pp. S252-S252
Author(s):  
G. Pontoni ◽  
M. Maur ◽  
R. Ferrari ◽  
A. Guida ◽  
S. Poletti ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Cancer Patients ◽  
Case Control Study ◽  
Psychological Symptoms ◽  
Daily Practice ◽  
Case Control ◽  
Depression And Anxiety ◽  
Control Study

BackgroundMindfulness based interventions (MBIs) have shown efficacy in improving psychological symptoms including depression and anxiety in cancer patients (pts). The study aimed to explore feasibility and reproducibility of MBIs in an Italian Cancer Centre measuring biochemical and psychological parameters.MethodsIn this pilot prospective case-control study, we recruited newly diagnosed pts receiving adjuvant chemotherapy (CT). A MBIs program was designed consisting of 2.5 hours weekly for 8 weeks and, including meditation, yoga and body scan. Material for 45 minutes (mn) home daily practice was provided. Primary endpoint was to evaluate feasibility. Secondary endpoints were assessment of quality of life (QoL), psychological and biochemical outcomes of stress, tested at baseline (W0), W4, W8, W24, W48. PSS (Perceived Stress Reduction), POMS (profile of mood states scores), EuroQoL (EQ-5D-3L) were administered.ResultsTen pts underwent MBIs program arm. We present preliminary results, while data of control arm are being collected. All pts were female, two pts (20%) dropped out. Median age was 56 years. All received adjuvant CT, 5/8 received radiotherapy and hormone therapy. Mean of sessions attending was 6.8 (76%). Median daily practice was 30 mn. EQ-5D item for depression and anxiety showed decreasing trend in mean score from moderate to light (P = 0.15) and significant improvement of auto-perceived QoL was observed comparing W0 and W8 (P = 0.02)ConclusionsIn a sensitive setting such as start CT, we found high pts compliance to MBIs. Improvement in self-perceived QoL after starting program was found and comparing anxious-depressive symptoms outcomes with control arm is still needed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

119 Clinical Decision Support System (CDSS) on Medication-Related Fall Risk: Wishes and Needs of European Physicians

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv28-iv33
Author(s):  
Kim Ploegmakers ◽  
Annemiek Linn ◽  
Stephanie Medlock ◽  
Nathalie Van der Velde ◽  
Julia Van Weert
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Clinical Decision Support ◽  
Support System ◽  
Medication Review ◽  
Fall Risk ◽  
Clinical Decision Support System ◽  
Clinical Decision ◽  
Barriers And Facilitators ◽  
To Receive

Abstract Background Medication is the second most important cause of falls in older adults, after mobility impairments. Doctors struggle to withdraw Fall Risk Increasing Drugs (FRIDs). They tend to overestimate the beneficial effect of medication and underestimate the risk of side effects. With an online survey we explored if 1) European doctors want digital support during medication review of older fallers by presentation of a personalized fall risk estimation of a patient and 2) what potential barriers and facilitators exist for the use of a Clinical Decision Support System (CDSS) that communicates fall risk. Methods We performed online surveys in 10 European countries among 359 European physicians who care for older fallers. 68% of the participants were geriatricians. Results 88% of physicians would like to receive help with performing a medication review. Barriers for usage that were mentioned most frequently were: technical issues (74%), indicating a reason when overriding an alert (62%) and unclear advice (60%). Most important facilitators were if the system: is beneficial to patient care (75%), is user friendly (74%) and fits into the workflow (66%) Conclusion most physicians would like to receive help from a CDSS when performing a medication review. For a successful implementation the barriers and facilitators found must be taken into account during development of the system as well as differences between countries.

scholarly journals Implementation of the Goal-directed Medication review Electronic Decision Support System (G-MEDSS)© into home medicines review: a protocol for a cluster-randomised clinical trial in older adults

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lisa Kouladjian O’Donnell ◽  
Mouna Sawan ◽  
Emily Reeve ◽  
Danijela Gnjidic ◽  
Timothy F. Chen ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Support ◽  
Decision Support System ◽  
Clinical Outcomes ◽  
Support System ◽  
Medication Review ◽  
Clinical Decision ◽  
Randomised Clinical Trial ◽  
Patient Specific ◽  
Electronic Decision Support System

Abstract Background Older people living in the community have a high prevalence of polypharmacy and are vulnerable to adverse drug events. Home Medicines Review (HMR) is a collaborative medication review service involving general practitioners (GPs), accredited clinical pharmacists (ACPs) and patients, which aims to prevent medication-related problems. This study aims to evaluate the implementation of a Computerised Clinical Decision Support System (CCDSS) called G-MEDSS© (Goal-directed Medication Review Electronic Decision Support System) in HMRs to deprescribe anticholinergic and sedative medications, and to assess the effect of deprescribing on clinical outcomes. Methods This study consists of 2 stages: Stage I – a two-arm parallel-group cluster-randomised clinical trial, and Stage II – process evaluation of the CCDSS intervention in HMR. Community-dwelling older adults living with and without dementia who are referred for HMR by their GP and recruited by ACPs will be included in this study. G-MEDSS is a CCDSS designed to provide clinical decision support for healthcare practitioners when completing a medication review, to tailor care to meet the patients’ goals and preferences. The G-MEDSS contains three tools: The Goals of Care Management Tool, The Drug Burden Index (DBI) Calculator©, and The revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. The G-MEDSS produces patient-specific deprescribing reports, to be included as part of the ACPs communication with the patient’s GP, and patient-specific reports for the patient (or carer). ACPs randomised to the intervention arm of the study will use G-MEDSS to create deprescribing reports for the referring GP and for their patient (or carer) when submitting the HMR report. ACPs in the comparison arm will provide the usual care HMR service (without the G-MEDSS). Outcomes The primary outcome is reduction in DBI exposure 3 months after HMR ± G-MEDSS intervention between comparison and intervention groups. The secondary outcomes include changes in clinical outcomes (physical and cognitive function, falls, institutionalisation, GP visits, medication adherence and mortality) 3-months after HMR. Discussion This study is expected to add to the evidence that the combination of CCDSS supporting medication review can improve prescribing and clinical outcomes in older adults. Trial registration The trial was registered on the Australian New Zealand Clinical Trials Registry ACTRN12617000895381 on 19th June 2017.

Implementation of the goal-directed medication review electronic decision support system (G-MEDSS)

2018 ◽  
Vol 14 (8) ◽  
pp. e42-e43 ◽  
Author(s):  
Mouna Sawan ◽  
Lisa Kouladjian O’Donnell ◽  
Emily Reeve ◽  
Danijela Gnjidic ◽  
Timothy Chen ◽  
...  
Keyword(s):  
Decision Support ◽  
Decision Support System ◽  
Support System ◽  
Medication Review ◽  
Electronic Decision Support ◽  
Electronic Decision Support System
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