scholarly journals Defining Potentially Inappropriate Prescriptions for Hypoglycaemic Agents to Improve Computerised Decision Support: A Study Protocol

Healthcare ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. 1539
Author(s):  
Paul Quindroit ◽  
Nicolas Baclet ◽  
Erwin Gerard ◽  
Laurine Robert ◽  
Madleen Lemaitre ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Decision Support ◽  
Inappropriate Prescribing ◽  
Automated Detection ◽  
Hypoglycaemic Agents ◽  
Support Tools ◽  
Multistep Process ◽  
Drug Treatments ◽  
Inappropriate Prescriptions

In France, around 5% of the general population are taking drug treatments for diabetes mellitus (mainly type 2 diabetes mellitus, T2DM). Although the management of T2DM has become more complex, most of these patients are managed by their general practitioner and not a diabetologist for their antidiabetics treatments; this increases the risk of potentially inappropriate prescriptions (PIPs) of hypoglycaemic agents (HAs). Inappropriate prescribing can be assessed by approaches that are implicit (expert judgement based) or explicit (criterion based). In a mixed, multistep process, we first systematically reviewed the published definitions of PIPs for HAs in patients with T2DM. The results will be used to create the first list of explicit definitions. Next, we will complete the definitions identified in the systematic review by conducting a qualitative study with two focus groups of experts in the prescription of HAs. Lastly, a Delphi survey will then be used to build consensus among participants; the results will be validated in consensus meetings. We developed a method for determining explicit definitions of PIPs for HAs in patients with T2DM. The resulting explicit definitions could be easily integrated into computerised decision support tools for the automated detection of PIPs.

scholarly journals A Mobile Computerized Decision Support System to Prevent Hypoglycemia in Hospitalized Patients With Type 2 Diabetes Mellitus

2016 ◽  
Vol 11 (1) ◽  
pp. 20-28 ◽  
Author(s):  
Stephan Spat ◽  
Klaus Donsa ◽  
Peter Beck ◽  
Bernhard Höll ◽  
Julia K. Mader ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Decision Support ◽  
Feasibility Study ◽  
Health Care Professionals ◽  
Diabetes Management ◽  
Insulin Dose ◽  
User Acceptance

Background: Diabetes management requires complex and interdisciplinary cooperation of health care professionals (HCPs). To support this complex process, IT-support is recommended by clinical guidelines. The aim of this article is to report on results from a clinical feasibility study testing the prototype of a mobile, tablet-based client-server system for computerized decision and workflow support (GlucoTab®) and to discuss its impact on hypoglycemia prevention. Methods: The system was tested in a monocentric, open, noncontrolled intervention study in 30 patients with type 2 diabetes mellitus (T2DM). The system supports HCPs in performing a basal-bolus insulin therapy. Diabetes therapy, adverse events, software errors and user feedback were documented. Safety, efficacy and user acceptance of the system were investigated. Results: Only 1.3% of blood glucose (BG) measurements were <70 mg/dl and only 2.6% were >300 mg/dl. The availability of the system (97.3%) and the rate of treatment activities documented with the system (>93.5%) were high. Only few suggestions from the system were overruled by the users (>95.7% adherence). Evaluation of the 3 anonymous questionnaires showed that confidence in the system increased over time. The majority of users believed that treatment errors could be prevented by using this system. Conclusions: Data from our feasibility study show a significant reduction of hypoglycemia by implementing a computerized system for workflow and decision support for diabetes management, compared to a paper-based process. The system was well accepted by HCPs, which is shown in the user acceptance analysis and that users adhered to the insulin dose suggestions made by the system.

Gender-specific effects of oral hypoglycaemic agents on cancer risk in type 2 diabetes mellitus

2013 ◽  
Vol 16 (3) ◽  
pp. 276-283 ◽  
Author(s):  
G. E. C. Sun ◽  
B. J. Wells ◽  
K. Yip ◽  
R. Zimmerman ◽  
D. Raghavan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cancer Risk ◽  
Oral Hypoglycaemic Agents ◽  
Hypoglycaemic Agents ◽  
Specific Effects ◽  
Gender Specific

scholarly journals Reducing Potentially Inappropriate Prescriptions for Older Patients Using Computerized Decision Support Tools: Systematic Review (Preprint)

2019 ◽  
Author(s):  
Luís Monteiro ◽  
Tiago Maricoto ◽  
Isabel Solha ◽  
Inês Ribeiro-Vaz ◽  
Carlos Martins ◽  
...  
Keyword(s):  
Decision Support ◽  
Randomized Controlled Trials ◽  
Controlled Trials ◽  
Potentially Inappropriate Medications ◽  
Decision Support Tools ◽  
Computerized Decision Support ◽  
Randomized Controlled ◽  
Support Tools ◽  
Inappropriate Medications ◽  
Inappropriate Prescriptions

BACKGROUND Older adults are more vulnerable to polypharmacy and prescriptions of potentially inappropriate medications. There are several ways to address polypharmacy to prevent its occurrence. We focused on computerized decision support tools. OBJECTIVE The available literature was reviewed to understand whether computerized decision support tools reduce potentially inappropriate prescriptions or potentially inappropriate medications in older adult patients and affect health outcomes. METHODS Our systematic review was conducted by searching the literature in the MEDLINE, CENTRAL, EMBASE, and Web of Science databases for interventional studies published through February 2018 to assess the impact of computerized decision support tools on potentially inappropriate medications and potentially inappropriate prescriptions in people aged 65 years and older. RESULTS A total of 3756 articles were identified, and 16 were included. More than half (n=10) of the studies were randomized controlled trials, one was a crossover study, and five were pre-post intervention studies. A total of 266,562 participants were included; of those, 233,144 participants were included and assessed in randomized controlled trials. Intervention designs had several different features. Computerized decision support tools consistently reduced the number of potentially inappropriate prescriptions started and mean number of potentially inappropriate prescriptions per patient. Computerized decision support tools also increased potentially inappropriate prescriptions discontinuation and drug appropriateness. However, in several studies, statistical significance was not achieved. A meta-analysis was not possible due to the significant heterogeneity among the systems used and the definitions of outcomes. CONCLUSIONS Computerized decision support tools may reduce potentially inappropriate prescriptions and potentially inappropriate medications. More randomized controlled trials assessing the impact of computerized decision support tools that could be used both in primary and secondary health care are needed to evaluate the use of medication targets defined by the Beers or STOPP (Screening Tool of Older People’s Prescriptions) criteria, adverse drug reactions, quality of life measurements, patient satisfaction, and professional satisfaction with a reasonable follow-up, which could clarify the clinical usefulness of these tools. CLINICALTRIAL International Prospective Register of Systematic Reviews (PROSPERO) CRD42017067021; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017067021

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