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Information technology interventions

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Daniel Arsenault

on 11 April 2016

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Transcript of Information technology interventions

IT Interventions in Primary Healthcare
Improvement in patient outcomes through enhancing collaborative practice and safety
Overview
A systematic review of RCTs

Inclusion Criteria
1. Intervention based on IT
2. Intervention performed in primary care
3. Outcomes were on reported medication safety
4. Only RCTs

A Policy-maker's perspective
Clinical decision Support
CDS seemed to be successful when tailored to specific medication cases or subsets.
Study design
Systematic review
RCT
Replicable
Data extraction
Third party reviewer
Clear methods
Languages
Patients
Diverse group of patients studied

Strengths
Group 3: Information technology interventions
to improve medication safety in primary
care: a systematic review

Directions for Future Study
As a policymaker, there is not enough conclusive evidence in this paper to support the widespread implementation of any one of these IT primary care intervention systems.
Collaboration between pharmacists and physicians seemed to have a positive effect on reducing the incidence of medical errors. This was supported by a reference to a RCT of a system called the pharmacist-led information technology intervention for medication errors (PINCER).
However, this RCT was not evaluated in the systematic review (it was published outside of the search date range).
PINCER
PINCER protocol: Collaboration between pharmacist and physicians to best identify and counter medication errors, coupled with improved education and patient counseling. (Avery et al, 2009)
The PINCER trial was successful in reducing medication errors and in the monitoring of errors associated with NSAIDs, beta-blockers, and ACE inhibitors. (Avery et al, 2012)
Promising IT primary care intervention systems such as CDS and pharmacist-led IT interventions should be further researched and optimized prior to wide-spread implementation.
CDS and CPOE
Standardized high quality RCTs examining the effect of IT interventions on medication safety in primary care settings are needed.
Computerized Provider Order Entry (CPOE) is an integrated IT framework that houses patient data and acts a means for the clinical team to operate best.
Such systems also include Clinical Decision Support.
Universally agreed as ideal environment, but costly and prone to being outdated, misused and underused.
Weaknesses
Inclusion and exclusion criteria
Excluded everything except RCT
Inclusion criteria had many definitions
Included studies
Only ten RCT met inclusion criteria, and of that only three showed reductions in unsafe prescribing
Only three studies included follow up information
Study durations ranged from 3-30 months
Bias
Extensive
Inadequate blinding and concealment of allocation in majority of studies
Lack of generalization
RESULTS
Research Question
P: Patients receiving medication in any primary care setting
I: any IT intervention
O: improvement of medication safety
Questions?
Thank you for your attention,
we would be happy to entertain
your questions
CPOE with CDS
3 of 6 studies evaluated effectively reduced unsafe prescribing

Consider alert fatigue with CDS


Pharmacists led IT intervention
Of the two studies evaluated, both decreased prescribing of potentially inappropriate medication in elderly or unsafe prescribing in pregnancy
Web Based and Telemedicine
Neither showed reduction in ADEs

Neither had medication safety as a primary outcome however, ADEs were important secondary outcomes
What else?
A 2007 retrospective file review of 1801 drug prescription in out-patient in medical walk-in clinic

The drug interaction database correctly identified 81% of clinically relevant adverse drug interactions, but also flagged up several clinically non significant interactions

A 2010 quasiexperimental, pretest-post-test study examined the impact of CPOE in primary care.

5,016 prescriptions written by hand before using the system were compared with 5,153 electronically prescribed documents.

10% reduction in prescribing error (18% to 8%) such as illegibility errors, use of inappropriate abbreviations, and missing information
A 2014 systematic review of 16 studies that met the inclusion criteria concluded that hospital use of CPOE showed more than 50% reduction in preventable ADEs.

A 2014 study on cost-effectiveness of CPOE in improving medication safety showed that it was in fact cost-effective and also decreased medication errors and ADEs.




Directions for Future Study
Reducing safety concerns with IT systems used in healthcare
Focusing on a limited number of relevant drugs and target groups
References
Avery A, Rodgers S, Cantrill J, Armstrong S, Cresswell K, Eden M et al. A pharmacist-led information technology intervention for medication errors (PINCER): a multicentre, cluster randomised, controlled trial and cost-effectiveness analysis. The Lancet. 2012;379(9823):1310-1319.
Avery A, Rodgers S, Cantrill J, Armstrong S, Elliott R, Howard R et al. Protocol for the PINCER trial: a cluster randomised trial comparing the effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices. Trials. 2009;10(1):28.
Shortliffe EH, Davis R, Axline SG, et al. Computer-based consultations in clinical therapeutics: Explanation and rule acquisition capabilities of the MYCIN system. Comput Biomed Res 1975;8:303-320.
National Steering Committee on Patient Safety. Building a Safer System: A National Integrated Strategy for Improving Patient Safety in Canadian Health Care. Ottawa: National Steering Committee on Patient Safety, 2002.
Devine E, Hansen R, Wilson-Norton J, Lawless N, Fisk A, Blough D et al. The impact of computerized provider order entry on medication errors in a multispecialty group practice. Journal of the American Medical Informatics Association. 2010;17(1):78-84.
Dallenbach M, Bovier P, Desmeules J. Detecting drug interactions using personal digital assistants in an out-patient clinic. QJM. 2007;100(11):691-697.
Forrester S, Hepp Z, Roth J, Wirtz H, Devine E. Cost-Effectiveness of a Computerized Provider Order Entry System in Improving Medication Safety Ambulatory Care. Value in Health. 2014;17(4):340-349.
Nuckols T, Smith-Spangler C, Morton S, Asch S, Patel V, Anderson L et al. The effectiveness of computerized order entry at reducing preventable adverse drug events and medication errors in hospital settings: a systematic review and meta-analysis. Systematic Reviews. 2014;3(1):56
Intra/Inter IT systems comparisons of efficacy in regards to improving medication safety in primary care settings.
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