Medication Use among Veterans across Health Care Systems

SummaryIntroduction: Dual healthcare system use can create gaps and fragments of information for patient care. The Department of Veteran Affairs is implementing a health information exchange (HIE) program called the Virtual Lifetime Electronic Record (VLER), which allows providers to access and share information across healthcare systems. HIE has the potential to improve the safety of medication use. However, data regarding the pattern of outpatient medication use across systems of care is largely unknown. Therefore, the objective of this study is to describe the prevalence of medication dispensing across VA and non-VA health care systems among a cohort Veteran population Methods: This study included all Veterans who had two outpatient visits or one inpatient visit at the Indianapolis VA during a 1-year period prior to VLER enrollment. Source of medication data was assessed at the subject level, and categorized as VA, INPC (non-VA), or both. The primary target was identification of sources for medication data. Then, we compared the mean number of prescriptions, as well as overall and pairwise differences in medication dispensing.Results: Out of 52,444 Veterans, 17.4% of subjects had medication data available in a regional HIE. On average, 40 prescriptions per year were prescribed for Veterans who used both sources compared to 29 prescriptions per year from VA only and 25 prescriptions per year from INPC only sources. The annualized prescription rate of Veterans in the dual use group was 36% higher than those who had only VA data available and 61% higher than those who had only INPC data available.Conclusions: Our data demonstrated that 17.4% of subjects had medication use identified from non-VA sources, including prescriptions for antibiotics, antineoplastics, and anticoagulants. These data support the need for HIE programs to improve coordination of information, with the potential to reduce adverse medication interactions and improve medication safety.

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Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak (Preprint)

10.2196/preprints.19106 ◽

2020 ◽

Author(s):

Pol Pérez Sust ◽

Oscar Solans ◽

Joan Carles Fajardo ◽

Manuel Medina Peralta ◽

Pepi Rodenas ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Information Exchange ◽

Health Information Exchange ◽

Digital Health ◽

Health Care Systems ◽

Public Health Care ◽

Health Technologies ◽

Health Strategy ◽

Care Systems

UNSTRUCTURED Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia.

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Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak

JMIR Public Health and Surveillance ◽

10.2196/19106 ◽

2020 ◽

Vol 6 (2) ◽

pp. e19106 ◽

Cited By ~ 18

Author(s):

Pol Pérez Sust ◽

Oscar Solans ◽

Joan Carles Fajardo ◽

Manuel Medina Peralta ◽

Pepi Rodenas ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Information Exchange ◽

Health Information Exchange ◽

Digital Health ◽

Health Care Systems ◽

Public Health Care ◽

Health Technologies ◽

Health Strategy ◽

Care Systems

Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia.

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Preventing Medication Errors with Antineoplastic Agents, Part 1

Hospital Pharmacy ◽

10.1177/001857870003500502 ◽

2000 ◽

Vol 35 (5) ◽

pp. 511-526 ◽

Cited By ~ 10

Author(s):

M. Christina Beckwith ◽

Linda S. Tyler

Keyword(s):

Health Care ◽

Medication Error ◽

Medication Errors ◽

Antineoplastic Agents ◽

Health Care Systems ◽

Medication Use ◽

Prescribing Errors ◽

Care Systems

Goal — The goal of this program is to present practical ways to prevent medication errors with antineoplastic agents, identify common types of medication errors, and describe a system for reducing the incidence of medication errors and responding appropriately to antineoplastic medication errors. Objectives — At the completion of this program, the participant will be able to: 1. Describe the scope and impact of medication errors 2. Define common terms used in medication error literature. 3. List four common types of prescribing errors made with anti-neoplastic agents. 4. Identify steps where medication errors may occur during the drug ordering, preparation, and administration process. 5. Describe ways to prevent errors at each step of the medication use process. 6. Recommend a procedure for reporting and monitoring antineoplastic medication errors within the institution. 7. Describe a system for the non-punitive management of antineoplastic medication errors in health care systems.

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An International Perspective on Health Information Exchange: Adoption in OECD Countries With Different Health Care System Configurations

Medical Care Research and Review ◽

10.1177/1077558719858245 ◽

2019 ◽

Vol 77 (4) ◽

pp. 299-311 ◽

Cited By ~ 1

Author(s):

Claudia Guerrazzi

Keyword(s):

Health Care ◽

Health Insurance ◽

Health Information ◽

Health Systems ◽

Information Exchange ◽

Health Information Exchange ◽

Essential Feature ◽

Health Care Systems ◽

Social Health Insurance ◽

Care Providers

The sharing of information among various care providers is becoming an essential feature of health care systems, and many countries are now adopting policies to foster health information exchange, defined as the electronic transfer of data or information among health care organizations involved in the delivery of care. Given the increasing adoption of this type of policy in several Organization for Economic Cooperation and Development countries, it is important to compare experiences from different countries, because policy adoption in one country can be explained more comprehensively and coherently through comparison with similar policies adopted in other nations. To make a more meaningful cross-country comparison, this article identifies a taxonomy of health systems, and it analyzes institutional and resource-based factors related to health information exchange adoption and how they differ in three main types of health systems: the National Health Service, social health insurance, and private health insurance.

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Gamification as an Enabler of Mutual Learning in Complex Health Care Systems

International Journal of E-Services and Mobile Applications ◽

10.4018/ijesma.2016100103 ◽

2016 ◽

Vol 8 (4) ◽

pp. 35-47

Author(s):

Johanna Leväsluoto ◽

Jouko Heikkilä ◽

Joona Tuovinen ◽

Kaupo Viitanen

Keyword(s):

Health Care ◽

Complex Systems ◽

Change Process ◽

Information Exchange ◽

Health Care Systems ◽

The Other ◽

Mutual Learning ◽

Care Systems ◽

Switching Method ◽

Systemic Understanding

In this paper, the authors present a gamified role switching method to promote dialogue and mutual learning in health care organisations facing changes in complex systems. Their research is based on two case studies in which the information exchange between the actors is crucial. 25 stakeholders were interviewed and four workshops were arranged. This study indicates that the gamified role switching method inspired and gave means for the participants to enhance systemic understanding of their organization and to improve dialogue. The role switching method also made the participants to see the situation from the other perspectives and thus promoted collaboration and the change process.

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Staff Competence in Dealing with Traditional Approaches

European Psychiatry ◽

10.1016/s0924-9338(08)70063-4 ◽

2008 ◽

Vol 23 (S1) ◽

pp. s59-s68 ◽

Cited By ~ 12

Author(s):

M. Kastrup

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Health Professionals ◽

Health Professionals ◽

Cultural Context ◽

Systems Of Care ◽

Health Care Systems ◽

Value Systems ◽

Care Systems ◽

Traditional Approaches

AbstractHealth care and health care systems should be seen and understood in their socio-cultural context. Modern urbanized societies are likely to exhibit health care pluralism, and different therapeutic approaches are available side-by-side. The various models may take their origin in different cultural traditions, but in most societies one type of care is at a given time considered “above” the others. However health care activities in all societies show a degree of interrelation, reflecting societal changes in which normative practices, value systems and structures change over time. In the current Western health systems evidence-based biomedical care is the prevailing system taught to all professionals.The present paper outlines the prevailing health paradigms, and the advantages and shortcomings of the various approaches and their relation to modern care will be discussed. With increased multicultural backgrounds of patients there is a need for mental health professionals to recognize the existence of traditional approaches and be aware of the parallel systems of care. Competent treatment of such patients requires that mental health professionals are aware of this and exhibit a willingness and ability to bridge between the more traditional and the Western approaches to treatment. The delineations and various aspects of the concept cultural competence and its dimensions will be discussed from a clinical perspective.Comparative studies of the various Western and the traditional approaches respectively will be reviewed.

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Screening for psychiatric morbidity in the population - a comparison of the GHQ-12 and self-reported medication use

International Journal for Population Data Science ◽

10.23889/ijpds.v3i1.414 ◽

2018 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Foteini Tseliou ◽

Michael Donnelly ◽

Dermot O'Reilly

Keyword(s):

Health Care ◽

Older People ◽

Health Care Services ◽

Economic Status ◽

Health Care Systems ◽

Psychiatric Morbidity ◽

Medication Use ◽

Screening Tools ◽

Care Systems ◽

Population Mental Health

IntroductionUptake of psychotropic medication has been previously used as a proxy for assessing the prevalence of population mental health morbidity. However, it is not known how this compares with estimates derived from population screening tools. ObjectivesTo compare estimates of psychiatric morbidity derived by a validated screening instrument of psychiatric morbidity and a self-reported medication uptake measure. MethodsThis study used data from two recent population-wide health surveys in Northern Ireland, a country (UK) with free health services and no prescription charges. The psychiatric morbidity of 7,489 respondents was assessed using the GHQ-12 and self-reported use of medication for stress, anxiety and depression (sDAS medication). ResultsOverall, 19% of respondents were defined as ‘cases’ and 14.3% were taking sDAS medication. Generally, the two methods identified the same population distributions of characteristics that were associated with psychiatric morbidity though nearly as many non-cases as cases received sDAS medication (46.4% vs. 53.6%). A greater proportion of women and older people were identified as cases according to sDAS medication use, while no such variation was observed between socio-economic status and method of assessment. ConclusionsThis study indicates that these two methods of assessing population psychiatric morbidity provide similar estimates, despite potentially identifying different individuals as cases. It is important to note that different health care systems might be linked to variations in obstacles when accessing and using health care services. Highlights There was a reasonable correspondence between the different methods of assessment. A greater proportion of women and older people were identified as cases through the self-reported use of medication. An almost equal amount of GHQ-12 cases and non-cases reported being in receipt of medication.

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