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Michaeli T, Michaeli DT. Partial Orphan Cancer Drugs: US Food and Drug Administration Approval, Clinical Benefit, Trials, Epidemiology, Price, Beneficiaries, and Spending. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:449-457. [PMID: 38244983 DOI: 10.1016/j.jval.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/14/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES The Orphan Drug Act (ODA) incentivizes drug development for rare diseases with limited sales potential. Partial orphans-drugs used to treat rare and common diseases-frequently turn into multi-billion dollar blockbusters. This study analyzes partial orphan cancer drugs' development, approval, and economics. METHODS 170 drugs with US Food and Drug Administration approval for 455 cancer indications were identified (2000-2021). 110 full, 22 partial, and 38 non-orphan drugs were compared regarding their approval, benefits, trials, epidemiology, price, beneficiaries, and spending with data from regulatory documents, Global Burden of Disease study, and Medicare and Medicaid. RESULTS Full orphans, relative to partial and non-orphans, were more frequently monotherapies for hematologic cancers supported by smaller single-arm trials treating diseases with a lower incidence and higher severity. The time from first to second indication approval was 1 year shorter for partial than full orphans. Full orphans offered a greater overall survival (median: 4.0 vs 2.8 vs 2.8 months, P < .001) and progression-free survival benefit (median: 5.1 vs 2.5 vs 3.6 months, P < .001). Monthly prices were higher for full and partial than non-orphan drugs (median: $17 177 vs $13 284 vs $12 457, P < .001). Beneficiaries (8790 vs 4390 vs 1730) and spending ($570 vs $305 vs $156 million) per drug were greater for partial than non-and full orphans. CONCLUSIONS Although partial orphans' benefits, trials, and economics are more similar to non-than full orphans, they receive all of the ODA's benefits and are swiftly extended to new indications; resulting in greater spending. A maximum ODA revenue/patient threshold could limit expenditure on partial orphans.
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Affiliation(s)
- Thomas Michaeli
- Department of Personalized Oncology, University Hospital Mannheim, Heidelberg University, Mannheim, Germany; DKFZ-Hector Cancer Institute at the University Medical Center Mannheim, Mannheim, Germany; Division of Personalized Medical Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany; Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany
| | - Daniel Tobias Michaeli
- Schumpeter School of Business and Economics, University of Wuppertal, Wuppertal, Germany; Department of Medical Oncology, National Center for Tumor Diseases, Heidelberg University Hospital, Heidelberg, Germany.
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Mueller SK, Garabedian P, Goralnick E, Bates DW, Samal L. Advancing health information during interhospital transfer: An interrupted time series. J Hosp Med 2023; 18:1063-1071. [PMID: 37846028 DOI: 10.1002/jhm.13221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/21/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Although the transfer of patients between acute care hospitals (interhospital transfer, IHT) is common, health information exchange (HIE) during IHT remains inadequate, with fragmented communication and unreliable access to clinical information. This study aims to design, implement, and rigorously evaluate the implementation of a HIE platform to improve data access during IHT. METHODS AND ANALYSIS Study subjects include patients aged >18 transferred to the medical, cardiology, oncology, or intensive care unit (ICU) services at an 800-bed quaternary care hospital; and healthcare workers involved in their care. The first aim of this study is to optimize clinician workflow, data visualization, and interoperability through user-centered design sessions for HIE platform development. The second aim is to evaluate the impact of the intervention on clinician-reported medical errors among 500 pre- and 500 postintervention IHT patients using interrupted time series methodology, adjusting for confounding variables and temporal trends. The third aim is to evaluate intervention fidelity, use and perceived usability of the platform, and barriers and facilitators of implementation from interprofessional stakeholder input, using mixed-methods evaluation. The fourth aim is to consolidate key findings to create a toolkit for spread and sustainability. ETHICS AND DISSEMINATION We will track patient safety endpoints and clinician workflow burdens and ensure the protection of patient data throughout the study. We will disseminate our findings via the creation of a toolkit for spread and sustainability, partnering with our funder (AHRQ) for dissemination, and communicating our results via abstracts and publications.
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Affiliation(s)
- Stephanie K Mueller
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Eric Goralnick
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - David W Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lipika Samal
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Montazeri M, Khajouei R, Afraz A, Ahmadian L. A systematic review of data elements of computerized physician order entry (CPOE): mapping the data to FHIR. Inform Health Soc Care 2023; 48:402-419. [PMID: 37723918 DOI: 10.1080/17538157.2023.2255285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Medication errors are the third leading cause of death. There are several methods to prevent prescription errors, one of which is to use a Computerized Physician Order Entry system (CPOE). In a CPOE system, necessary data needs to be collected so that making decisions about prescribing medications and treatment plans could be made. Although many CPOE systems have been developed worldwide, studies have yet to identify the necessary data and data elements of CPOE systems. This study aims to identify data elements of CPOE and standardize these data with Fast Healthcare Interoperability Resources (FHIR) to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity. METHODS PubMed, Web of Science, Embase, and Scopus databases for studies up to October 2019 were searched. Two reviewers independently assessed original articles to determine eligibility for inclusion in this review. All articles describing data elements of a COPE system were included. Data elements were obtained from the included articles' text, tables, and figures.Classification of the extracted data elements and mapping them to FHIR was done to facilitate data sharing and integration with the electronic health record (EHR) system and reduce data diversity. The final data elements of CPOE were categorized into five main categories of FHIR (foundation, base, clinical, financial, and specialized) and 146 resources, where possible. One of the researchers did mapping and checked and verified by the second researcher. If a data element could not be mapped to any FHIR resources, this data element was considered an extension to the most relevant resource. RESULTS We retrieved 5162 articles through database searches. After the full-text assessment, 21 articles were included. In total, 270 data elements were identified and mapped to the FHIR standard. These elements have been reported in 26 FHIR resources of 146 ones (18%). In total, 71 data elements were considered an extension. CONCLUSIONS The results of this study showed that the same data elements were not used in the CPOE systems, and the degree of homogeneity of these systems is limited. The mapping of extracted data with data elements used in the FHIR standard shows the extent to which these systems comply with existing standards. Considering the standards in these systems' design helps developers design more coherent systems that can share data with other systems.
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Affiliation(s)
- Mahdieh Montazeri
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Khajouei
- Department of Health Information Sciences, Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Afraz
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Ahmadian
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Garabedian PM, Rui A, Volk LA, Neville BA, Lipsitz SR, Healey MJ, Bates DW. A Multiyear Survey Evaluating Clinician Electronic Health Record Satisfaction. Appl Clin Inform 2023; 14:632-643. [PMID: 37586414 PMCID: PMC10431971 DOI: 10.1055/s-0043-1770900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/12/2023] [Indexed: 08/18/2023] Open
Abstract
OBJECTIVES We assessed how clinician satisfaction with a vendor electronic health record (EHR) changed over time in the 4 years following the transition from a homegrown EHR system to identify areas for improvement. METHODS We conducted a multiyear survey of clinicians across a large health care system after transitioning to a vendor EHR. Eligible clinicians from the first institution to transition received a survey invitation by email in fall 2016 and then eligible clinicians systemwide received surveys in spring 2018 and spring 2019. The survey included items assessing ease/difficulty of completing tasks and items assessing perceptions of the EHR's value, usability, and impact. One item assessing overall satisfaction and one open-ended question were included. Frequencies and means were calculated, and comparison of means was performed between 2018 and 2019 on all clinicians. A multivariable generalized linear model was performed to predict the outcome of overall satisfaction. RESULTS Response rates for the surveys ranged from 14 to 19%. The mean response from 3 years of surveys for one institution, Brigham and Women's Hospital, increased for overall satisfaction between 2016 (2.85), 2018 (3.01), and 2019 (3.21, p < 0.001). We found no significant differences in mean response for overall satisfaction between all responders of the 2018 survey (3.14) and those of the 2019 survey (3.19). Systemwide, tasks rated the most difficult included "Monitoring patient medication adherence," "Identifying when a referral has not been completed," and "Making a list of patients based on clinical information (e.g., problem, medication)." Clinicians disagreed the most with "The EHR helps me focus on patient care rather than the computer" and "The EHR allows me to complete tasks efficiently." CONCLUSION Survey results indicate room for improvement in clinician satisfaction with the EHR. Usability of EHRs should continue to be an area of focus to ease clinician burden and improve clinician experience.
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Affiliation(s)
- Pamela M. Garabedian
- Clinical Quality and IS Analysis, Mass General Brigham, Inc., Somerville, Massachusetts, United States
| | - Angela Rui
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Lynn A. Volk
- Clinical Quality and IS Analysis, Mass General Brigham, Inc., Somerville, Massachusetts, United States
| | - Bridget A. Neville
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stuart R. Lipsitz
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Harvard University, Ariadne Labs, Boston, Massachusetts, United States
| | - Michael J. Healey
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
| | - David W. Bates
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Harvard Medical School, Boston, Massachusetts, United States
- Harvard School of Public Health, Harvard University, Boston, Massachusetts
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Grauer A, Rosen A, Applebaum JR, Carter D, Reddy P, Dal Col A, Kumaraiah D, Barchi DJ, Classen DC, Adelman JS. Examining medication ordering errors using AHRQ network of patient safety databases. J Am Med Inform Assoc 2023; 30:838-845. [PMID: 36718575 PMCID: PMC10114013 DOI: 10.1093/jamia/ocad007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/11/2023] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Studies examining the effects of computerized order entry (CPOE) on medication ordering errors demonstrate that CPOE does not consistently prevent these errors as intended. We used the Agency for Healthcare Research and Quality (AHRQ) Network of Patient Safety Databases (NPSD) to investigate the frequency and degree of harm of reported events that occurred at the ordering stage, characterized by error type. MATERIALS AND METHODS This was a retrospective observational study of safety events reported by healthcare systems in participating patient safety organizations from 6/2010 through 12/2020. All medication and other substance ordering errors reported to NPSD via common format v1.2 between 6/2010 through 12/2020 were analyzed. We aggregated and categorized the frequency of reported medication ordering errors by error type, degree of harm, and demographic characteristics. RESULTS A total of 12 830 errors were reported during the study period. Incorrect dose accounted for 3812 errors (29.7%), followed by incorrect medication 2086 (16.3%), and incorrect duration 765 (6.0%). Of 5282 events that reached the patient and had a known level of severity, 12 resulted in death, 4 resulted in severe harm, 45 resulted in moderate harm, 341 resulted in mild harm, and 4880 resulted in no harm. CONCLUSION Incorrect dose and incorrect drug orders were the most commonly reported and harmful types of medication ordering errors. Future studies should aim to develop and test interventions focused on CPOE to prevent medication ordering errors, prioritizing wrong-dose and wrong-drug errors.
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Affiliation(s)
- Anne Grauer
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - Amanda Rosen
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - Jo R Applebaum
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - Danielle Carter
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - Pooja Reddy
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Alexis Dal Col
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Deepa Kumaraiah
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - Daniel J Barchi
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
| | - David C Classen
- Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jason S Adelman
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York, USA
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Schiff GD, Lambert BL, Wright A. Prescribing medications with indications: time to flip the script. BMJ Qual Saf 2023; 32:315-318. [PMID: 36948544 DOI: 10.1136/bmjqs-2023-015923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Gordon D Schiff
- Center for Patient Safety Research and Practice, Division of General Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Bruce L Lambert
- Communication Studies, Northwestern University, Chicago, Illinois, USA
| | - Adam Wright
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Feather C, Appelbaum N, Darzi A, Franklin BD. Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis. BMJ Qual Saf 2023; 32:357-368. [PMID: 36788034 DOI: 10.1136/bmjqs-2022-015452] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/27/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Despite recommendations, documentation of indication on prescriptions and inpatient medication orders is not routinely practised. There has been a recent systematic review of indication documentation for antimicrobials, but not for interventions relating to indication documentation for medication more broadly. Our aims were to 1) identify, describe and synthesise the literature relating to effectiveness of interventions aimed at improving indication documentation and/or indication-based prescribing in both primary and secondary healthcare; 2) synthesise participant perspectives to identify barriers and facilitators to these interventions; and 3) make recommendations for both practice and research. METHODS A systematic literature search was conducted using Medline, Embase and CINAHL using two search concepts: electronic prescribing systems, and indication documentation and/or indication-based prescribing. Qualitative, quantitative and mixed-methods studies were included; outcome measures and results were extracted to produce a narrative synthesis. Quality appraisal by two independent reviewers was undertaken using the Mixed Methods Appraisal Tool. RESULTS We identified 21 studies evaluating interventions to aid indication documentation. Indication documentation was either via free-text, selection from a list, or by use of pre-defined indication-based order sentences for individual medications. For a number of outcomes, there was a mostly positive impact, including appropriateness of the medication order (6 of 8 studies), rates of prescribing error (2/2) and some less commonly reported clinical (2/4) and workflow-related outcomes (2/3). There was a less favourable impact on accuracy of indication documentation and rates of medication use, highlighting some unintended consequences that may occur when implementing new interventions. Participant insights from prescribers and other healthcare professionals complemented quantitative study results, highlighting both facilitators and barriers to indication documentation and the associated interventions. For example, barriers included long drop-down lists and the need to use workarounds to navigate approval systems due to time or knowledge constraints. Facilitating factors included the perceived benefits of indication documentation on communication among the healthcare team and with the patient. CONCLUSION Indication documentation has the potential to improve appropriate prescribing and reduce prescribing errors. However, further benefits to the prescriber, multidisciplinary team and patient may only be realised by developing methods of indication documentation that integrate more efficiently with prescriber workflows. PROSPERO REGISTRATION NUMBER CRD42021278495.
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Affiliation(s)
- Calandra Feather
- Department of Surgery and Cancer, Imperial College London, London, UK
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
| | | | - Ara Darzi
- Institute of Global Health Innovation at Imperial College London, London, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, London, UK
- Department of Practice and Policy, UCL School of Pharmacy, London, UK
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Saini S, Leung V, Si E, Ho C, Cheung A, Dalton D, Daneman N, Grindrod K, Ha R, McIsaac W, Oberai A, Schwartz K, Shiamptanis A, Langford BJ. Documenting the indication for antimicrobial prescribing: a scoping review. BMJ Qual Saf 2022; 31:787-799. [PMID: 35552253 DOI: 10.1136/bmjqs-2021-014582] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/05/2022] [Indexed: 12/19/2022]
Abstract
BACKGROUND Documenting an indication when prescribing antimicrobials is considered best practice; however, a better understanding of the evidence is needed to support broader implementation of this practice. OBJECTIVES We performed a scoping review to evaluate antimicrobial indication documentation as it pertains to its implementation, prevalence, accuracy and impact on clinical and utilisation outcomes in all patient populations. ELIGIBILITY CRITERIA Published and unpublished literature evaluating the documentation of an indication for antimicrobial prescribing. SOURCES OF EVIDENCE A search was conducted in MEDLINE, Embase, CINAHL and International Pharmaceutical Abstracts in addition to a review of the grey literature. CHARTING AND ANALYSIS Screening and extraction was performed by two independent reviewers. Studies were categorised inductively and results were presented descriptively. RESULTS We identified 123 peer-reviewed articles and grey literature documents for inclusion. Most studies took place in a hospital setting (109, 89%). The median prevalence of antimicrobial indication documentation was 75% (range 4%-100%). Studies evaluating the impact of indication documentation on prescribing and patient outcomes most commonly examined appropriateness and identified a benefit to prescribing or patient outcomes in 17 of 19 studies. Qualitative studies evaluating healthcare worker perspectives (n=10) noted the common barriers and facilitators to this practice. CONCLUSION There is growing interest in the importance of documenting an indication when prescribing antimicrobials. While antimicrobial indication documentation is not uniformly implemented, several studies have shown that multipronged approaches can be used to improve this practice. Emerging evidence demonstrates that antimicrobial indication documentation is associated with improved prescribing and patient outcomes both in community and hospital settings. But setting-specific and larger trials are needed to provide a more robust evidence base for this practice.
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Affiliation(s)
- Sharon Saini
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, Ontario, Canada
| | - Elizabeth Si
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Certina Ho
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Safe Medication Practices, Toronto, Ontario, Canada
| | - Anne Cheung
- West Park Healthcare Centre, Toronto, Ontario, Canada
| | | | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Rita Ha
- North York Family Health Team, Toronto, Ontario, Canada
| | - Warren McIsaac
- Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Anjali Oberai
- Wawa Family Health Team, Wawa, Ontario, Canada
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Kevin Schwartz
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Bradley J Langford
- Hotel Dieu Shaver Health and Rehabilitation Centre, St. Catharines, Ontario, Canada
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Lambert BL, Schiff GD. RaDonda
Vaught, medication safety, and the profession of pharmacy: Steps to improve safety and ensure justice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2022. [DOI: 10.1002/jac5.1676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Bruce L. Lambert
- Department of Communication Studies Northwestern University Chicago Illinois USA
| | - Gordon D. Schiff
- Center for Patient Safety Research and Practice Brigham and Women's Hospital Boston Massachusetts USA
- Center for Primary Care and Associate Professor of Medicine Harvard Medical School Boston Massachusetts USA
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Bassir F, Varghese S, Wang L, Chin YP, Zhou L. The Use of Electronic Health Records to Study Drug-Induced Hypersensitivity Reactions from 2000 to 2021. Immunol Allergy Clin North Am 2022; 42:453-497. [PMID: 35469629 PMCID: PMC9267416 DOI: 10.1016/j.iac.2022.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Electronic health records (EHRs) have revolutionized the field of drug hypersensitivity reaction (DHR) research. In this systematic review, we assessed 140 articles from 2000-2021, classifying them under six themes: observational studies (n=61), clinical documentation (n=27), case management (n=22), clinical decision support (CDS) (n=18), case identification (n=9), and genetic studies (n=3). EHRs provide convenient access to millions of medical records, facilitating epidemiological studies of DHRs. Though the goal of CDS is to promote safe drug prescribing, allergy alerts must be designed and used in a way that supports this effort. Ultimately, accurate allergy documentation is essential for DHR prevention.
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Affiliation(s)
- Fatima Bassir
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA; Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA.
| | - Sheril Varghese
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA
| | - Liqin Wang
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA
| | - Yen Po Chin
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 399 Revolution Drive, Suite 1315, Somerville, MA 02145, USA
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Whaley C, Bancsi A, Ho JMW, Burns CM, Grindrod K. Prescribers' perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis. BMC Health Serv Res 2021; 21:89. [PMID: 33499869 PMCID: PMC7836591 DOI: 10.1186/s12913-021-06103-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 01/19/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The indication for prescribing a particular medication, or its reason for use (RFU) is a crucial piece of information for all those involved in the circle of care. Research has shown that sharing RFU information with physicians, pharmacists and patients improves patient safety and patient adherence, however RFU is rarely added on prescriptions by prescribers or on medication labels for patients to reference. METHODS Qualitative interviews were conducted with 20 prescribers in Southern Ontario, Canada, to learn prescribers' current attitudes on the addition of RFU on prescriptions and medication labels. A trained interviewer used a semi-structured interview guide for each interview. The interviews explored how the sharing of RFU information would impact prescribers' workflows and practices. Interviews were recorded, transcribed and thematically coded. RESULTS The analysis yielded four main themes: Current Practice, Future Practice, Changing Culture, and Collaboration. Most of the prescribers interviewed do not currently add RFU to prescriptions. Prescribers were open to sharing RFU with colleagues via a regional database but wanted the ability to provide context for the prescribed medication within the system. Many prescribers were wary of the impact of adding RFU on their workflow but felt it could save time by avoiding clarifying questions from pharmacists. Increased interprofessional collaboration, increased patient understanding of prescribed medications, avoiding guesswork when determining indications and decreased misinterpretation regarding RFU were cited by most prescribers as benefits to including RFU information. CONCLUSIONS Prescribers were generally open to sharing RFU and clearly identified the benefits to pharmacists and patients if added. Critically, they also identified benefits to their own practices. These results can be used to guide the implementation of future initiatives to promote the sharing of RFU in healthcare teams.
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Affiliation(s)
- Colin Whaley
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Ashley Bancsi
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Joanne Man-Wai Ho
- Divisions of Geriatric Medicine & Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, Waterloo, N2J 0E2 ON Canada
- GeriMedRisk, 250 Laurelwood Drive, Waterloo, N2J 0E2 ON Canada
| | - Catherine M. Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Kelly Grindrod
- University of Waterloo School of Pharmacy, Health Sciences Campus, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
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Whaley C, Bancsi A, Ho JMW, Burns CM, Grindrod K. How do I keep myself safe? Patient perspectives on including reason for use information on prescriptions and medication labels: a qualitative thematic analysis. J Pharm Policy Pract 2020; 13:63. [PMID: 33042555 PMCID: PMC7541269 DOI: 10.1186/s40545-020-00268-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/02/2020] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT BACKGROUND Medications are crucial for maintaining patient wellness and improving health in modern medicine, but their use comes with risks. Helping patients to understand why they are taking medications is important for patient-centered care and facilitates patient adherence to prescribed medications. One strategy involves enhancing communication between patients, physicians, and pharmacists through the sharing of reason for use (RFU) information or the indication for medications. METHODS Semi-structured interviews were conducted with 20 patients in Ontario, Canada, to gain perspectives on how patients currently store their medication information and benefits and disadvantages of adding RFU to prescriptions and medication labels. An interview guide was used by the two interviewers, and the interviews were recorded, transcribed, and thematically coded. RESULTS The analysis yielded three main themes: patient decision making with RFU, RFU in modern, patient-centered care, and logistical aspects of communicating RFU. The patients that were interviewed expressed the value of having RFU when deciding if a medication was effective or to stop taking the medication. Patients felt comfortable with RFU being added to prescriptions and acknowledged the value in adding RFU to medication labels, helping patients and others identify and distinguish medications. Patients generally expressed interest in having RFU written in lay language and identified strengths and weaknesses of having access to RFU via a website or app. CONCLUSIONS Patients rated the importance of knowing RFU very highly, identified the value in sharing RFU with pharmacists on prescriptions, and in having RFU on medication labels. These results can be used to inform policy on the addition of RFU on prescriptions and medication labels and support improved communication between patients, pharmacists, and physicians about RFU.
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Affiliation(s)
- Colin Whaley
- School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Ashley Bancsi
- School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Joanne Man-Wai Ho
- Division of Geriatric Medicine, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Division of Clinical Pharmacology and Toxicology, Department of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, Waterloo, ON Canada
- GeriMedRisk, 250 Laurelwood Drive, Waterloo, ON Canada
| | - Catherine M. Burns
- Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
| | - Kelly Grindrod
- School of Pharmacy, University of Waterloo, 200 University Ave West, Waterloo, ON N2L 3G1 Canada
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Baysari MT, Moran M, Del Gigante J, Day RO. Indications-based prescribing: A challenge for hospital prescribers. Br J Clin Pharmacol 2020; 87:730-731. [PMID: 32875641 DOI: 10.1111/bcp.14532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/11/2020] [Accepted: 08/21/2020] [Indexed: 12/01/2022] Open
Affiliation(s)
- Melissa T Baysari
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Maria Moran
- Sydney School of Health Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Del Gigante
- Department of Pharmacy, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Richard O Day
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW, Sydney, New South Wales, Australia
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Whaley C, Bancsi A, Burns C, Grindrod K. Pharmacists' perspectives on the value of reason for use information. Can Pharm J (Ott) 2020; 153:294-300. [PMID: 33110470 DOI: 10.1177/1715163520946052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The indication for a particular medication, or its reason for use (RFU), is important information for prescribers, pharmacists and patients but is not often communicated in writing from prescribers to pharmacists. Adding RFU to a prescription and a medication label would ensure that pharmacists are confident that they are providing high-quality, accurate patient care. This study aims to describe the perspectives of pharmacists on how receiving RFU from prescribers would affect their practice and how pharmacists putting this information on prescriptions would affect patients. Methods Semi-structured qualitative interviews were conducted with 20 pharmacists in Southwestern Ontario. Thematic analysis was used to analyze the interview transcripts, leading to 4 major themes. Results Pharmacists expressed that RFU should be formatted to ensure that it is of clinical utility via the use of written text and noted that either medical or lay (also known as plain) language would be appropriate for use. Pharmacists indicated that patient privacy should be considered when writing RFU on labels and that patient preference with respect to the addition of RFU should dictate its inclusion on a medication label. Pharmacist access to RFU was universally acknowledged to improve patient safety by providing pharmacists with more information to determine whether the given medication was indicated. Conclusions This study provides further information about the impact that having access to RFU would have on pharmacy practice and can be used to advocate for the inclusion of RFU information with prescriptions to improve patient outcomes. Can Pharm J (Ott) 2020;153:xx-xx.
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Affiliation(s)
- Colin Whaley
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Ashley Bancsi
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Catherine Burns
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
| | - Kelly Grindrod
- School of Pharmacy (Whaley, Bancsi, Grindrod), Faculty of Engineering, Waterloo, Ontario.,Faculty of Science and the Department of Systems Design Engineering (Burns), Faculty of Engineering, Waterloo, Ontario
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Graber IBML. 2019 John M. Eisenberg Patient Safety and Quality Awards: An Interview with Gordon D. Schiff. Jt Comm J Qual Patient Saf 2020; 46:371-380. [PMID: 32598280 PMCID: PMC7189185 DOI: 10.1016/j.jcjq.2020.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Goss FR, Bookman K, Barron M, Bickley D, Landgren B, Kroehl M, Williamson K, Zane R, Wiler J. Improved antibiotic prescribing using indication-based clinical decision support in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:214-221. [PMID: 33000036 PMCID: PMC7493549 DOI: 10.1002/emp2.12029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/23/2019] [Accepted: 01/27/2020] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Evaluate an indication-based clinical decision support tool to improve antibiotic prescribing in the emergency department. METHODS Encounters where an antibiotic was prescribed between January 2015 and October 2017 were analyzed before and after the introduction of a clinical decision support tool to improve clinicians' selection of a guideline-approved antibiotic based on clinical indication. Evaluation was conducted on a pre-defined subset of conditions that included skin and soft tissue infections, respiratory infections, and urinary infections. The primary outcome was ordering of a guideline-approved antibiotic prescription at the drug and duration of therapy level. A mixed model following a binomial distribution with a logit link was used to model the difference in proportions of guideline-approved prescriptions before and after the intervention. RESULTS For conditions evaluated, selection rate of a guideline-approved antibiotic for a given indication improved from 67.1% to 72.2% (P < 0.001). When duration of therapy is included as a criterion, selection of a guideline-approved antibiotic was lower and improved from 24.7% to 31.4% (P < 0.001), highlighting that duration of therapy is often missing at the time of prescribing. The most substantial improvements were seen for pneumonia and pyelonephritis with an increase from 87.9% to 97.5% and 62.8% to 82.6%, respectively. Other significant improvements were seen for abscess, cellulitis, and urinary tract infections. CONCLUSION Antibiotic prescribing can be improved both at the drug and duration of therapy level using a non-interruptive and indication based-clinical decision support approach. Future research and quality improvement efforts are needed to incorporate duration of therapy guidelines into the antibiotic prescribing process.
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Affiliation(s)
- Foster R. Goss
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Kelly Bookman
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Michelle Barron
- University of Colorado School of MedicineAuroraColorado
- Department of Infection Prevention and ControlUniversity of Colorado HospitalAuroraColorado
| | - Daniel Bickley
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Brady Landgren
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | | | | | - Richard Zane
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
| | - Jennifer Wiler
- Department of Emergency MedicineUniversity of Colorado HospitalAuroraColorado
- University of Colorado School of MedicineAuroraColorado
- University of Colorado Denver School of BusinessDenverColorado
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