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Schulze Westhoff M, Schröder S, Groh A, Frieling H, Bleich S, Koop F, Stichtenoth DO, Krichevsky B, Heck J. Sedatives and analgesics are major contributors to potentially inappropriate duplicate prescriptions in geriatric psychiatry. Psychogeriatrics 2023; 23:354-363. [PMID: 36720843 DOI: 10.1111/psyg.12940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/07/2022] [Accepted: 01/12/2023] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study sought to investigate the frequency and characteristics of duplicate prescriptions (DPs) in elderly psychiatric inpatients using a novel categorisation of DPs that differentiates between appropriate duplicate prescriptions (ADPs) and potentially inappropriate duplicate prescriptions (PIDPs). METHODS The study was conducted as a monocentric retrospective cross-sectional pilot study on the gerontopsychiatric ward of the Department of Psychiatry, Social Psychiatry and Psychotherapy of Hannover Medical School, a large university hospital in northern Germany. The outcome measures were the nature and frequency of PIDPs compared with the frequency of ADPs. RESULTS For 92 individual patients a total of 339 medication chart reviews were conducted between April 2021 and February 2022. The median age of the study population was 73 years (interquartile range (IQR) 68-82 years); 64.6% were female. Patients' medications comprised a median of eight drugs (IQR 6-11 drugs) and 43.1% of the study population were exposed to at least one PIDP (at least one grade-1 PIDP: 39.5%; at least one grade-2 PIDP: 5.0%; at least one grade-3 PIDP: 1.5%). Sedatives were most frequently responsible for grade-1 and grade-2 PIDPs, while grade-3 PIDPs were elicited exclusively by analgesics. Nearly half of the study population (49.0%) displayed at least one ADP. CONCLUSION Even though the clinical implications of PIDPs are not fully established to date, we recommend that physicians who treat elderly psychiatric patients pay special attention to PIDPs, especially PIDPs elicited by sedatives. Termination of PIDPs may prevent adverse drug reactions and save healthcare expenditures.
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Affiliation(s)
- Martin Schulze Westhoff
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Sebastian Schröder
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Adrian Groh
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Bleich
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Felix Koop
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Dirk O Stichtenoth
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
| | - Benjamin Krichevsky
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany.,Medical Service of the German Armed Forces, Kiel, Germany
| | - Johannes Heck
- Institute for Clinical Pharmacology, Hannover Medical School, Hannover, Germany
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2
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Abbasi R, Alavi NM, Farzandipour M, Gong Y, Nabovati E. Using pharmacy surveillance information systems to Monitor the dispensing practice of under-controlled drugs: A qualitative study on necessities, requirements, and implementation challenges. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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3
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Bocknek L, Kim T, Spaar P, Russell J, Busog DN, Howe J, Boxley C, Ratwani R, Krevat S, Jones R, Franklin E. Duplicate Medication Order Errors: Safety Gaps and Recommendations for Improvement. PATIENT SAFETY 2022. [DOI: 10.33940/data/2022.9.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background: Duplicate medication orders are a prominent type of medication error that in some circumstances has increased after implementation of health information technology. Duplicate medication orders are commonly defined as two or more active
orders for the same medication or medications within the same therapeutic class. While there have been several studies that have identified contributing factors and described potential solutions, duplicate medication order errors continue to impact patient safety.
Methods: We analyzed 377 reports from 95 healthcare facilities to more granularly define the types of duplicate medication order errors and the context under which these errors occurred, as well as potential contributing factors.
Results: Of the 377 reports reviewed, 304 (80.6%) met the criteria to be defined as a duplicate medication order error. The most frequent duplicate medication order error type was same order (n=131, 43.1%), followed by same therapeutic class (n=98, 32.2%)
and same medication (n=70, 23.0%). Errors were identified during different medication process tasks and most commonly during medication reconciliation during the patient’s stay in the hospital (n=72, 23.7%) and during pharmacy verification (n=36, 11.8%). Factors contributing to these errors included health information technology issues (n=63, 20.7%), gaps in care coordination (n=44, 14.5%), and a prior dose or medication order not being discontinued (n=52, 17.1%).
Conclusion: Our results highlight specific areas for practice improvement, and we make recommendations for how healthcare facilities can better address duplicate medication order errors.
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Affiliation(s)
- Lucy Bocknek
- MedStar Health National Center for Human Factors in Healthcare
| | - Tracy Kim
- MedStar Health National Center for Human Factors in Healthcare
| | - Patricia Spaar
- MedStar Health National Center for Human Factors in Healthcare
| | | | | | - Jessica Howe
- MedStar Health National Center for Human Factors in Healthcare
| | | | - Raj Ratwani
- MedStar Health National Center for Human Factors in Healthcare
| | - Seth Krevat
- MedStar Health National Center for Human Factors in Healthcare
| | | | - Ella Franklin
- MedStar Health National Center for Human Factors in Healthcare
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4
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Chuang TJ, Wang YH, Wei JCC, Yeh CJ. Anti-gout Medications and Risk of Cardiovascular Disease: A Nested Case-Control Study. Front Med (Lausanne) 2021; 8:739680. [PMID: 34733863 PMCID: PMC8558358 DOI: 10.3389/fmed.2021.739680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/12/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Gout is the leading cause of inflammatory arthritis and is also correlated with multiple comorbidities, including cardiovascular disease (CVD), whose future risk can be lowered by urate-lowering therapy (ULT) in gout patients. It is, however, still not clear whether its effect is associated with the days of usage and the adherence rate of ULT. Methods: Data were collected from Taiwan's National Health Insurance Research Database. The study period was from 1999/1/1 to 2013/12/31. In addition, patients with newly diagnosed gout from 2000 to 2012 and usage of antigout preparations (allopurinol or benzbromarone) within half a year among age ≥20 years old were enrolled in the study. The outcome of interest is CVD. New diagnosis of CVD after half a year of diagnosis of gout was included in the CVD group. Moreover, conditional logistic regression was used to evaluate the odds ratio of CVD in relation to the days of usage and to the adherence rate of ULT after the adjustment for potentially confounding variables. Results: A total of 3,706 gout patients with and without CVD have been included in the final analysis after a 1:1 propensity score that matched for age, sex, comorbidities, aspirin, and statin. The days of usage of allopurinol was <180 days and benzbromarone, in its turn, presupposed a higher risk of CVD. The adherence rate of allopurinol and benzbromarone at ≥ 0.7 both have a lower CVD risk: allopurinol (adjusted OR: 0.66 95% CI: 0.46-0.96), benzbromarone (adjusted OR: 0.68 95% CI: 0.50-0.91). The subgroup analysis revealed an adherence rate of ≥0.7 of ULT with a lower CVD was only found to be present in males and at age <65. Furthermore, the correlations were more pronounced in the ischemic heart disease subgroup than in the cerebrovascular disease group. Conclusion: This study reveals that gout patients taking ULT (allopurinol and benzbromarone) with an adherence rate of ≥0.7 are at a lower risk of developing CVD, especially with a younger age (<65) and if they are male. On top of this, the benefit is more pronounced in ischemic heart disease. Despite further prospective trials needing to be warranted to confirm our findings, health care providers may, bearing these conclusions in mind, emphasize the importance of adherence to ULT in gout patients.
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Affiliation(s)
- Tsung-Ju Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jung Yeh
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
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5
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Hussain MI, Reynolds TL, Zheng K. Medication safety alert fatigue may be reduced via interaction design and clinical role tailoring: a systematic review. J Am Med Inform Assoc 2021; 26:1141-1149. [PMID: 31206159 DOI: 10.1093/jamia/ocz095] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Alert fatigue limits the effectiveness of medication safety alerts, a type of computerized clinical decision support (CDS). Researchers have suggested alternative interactive designs, as well as tailoring alerts to clinical roles. As examples, alerts may be tiered to convey risk, and certain alerts may be sent to pharmacists. We aimed to evaluate which variants elicit less alert fatigue. MATERIALS AND METHODS We searched for articles published between 2007 and 2017 using the PubMed, Embase, CINAHL, and Cochrane databases. We included articles documenting peer-reviewed empirical research that described the interactive design of a CDS system, to which clinical role it was presented, and how often prescribers accepted the resultant advice. Next, we compared the acceptance rates of conventional CDS-presenting prescribers with interruptive modal dialogs (ie, "pop-ups")-with alternative designs, such as role-tailored alerts. RESULTS Of 1011 articles returned by the search, we included 39. We found different methods for measuring acceptance rates; these produced incomparable results. The most common type of CDS-in which modals interrupted prescribers-was accepted the least often. Tiering by risk, providing shortcuts for common corrections, requiring a reason to override, and tailoring CDS to match the roles of pharmacists and prescribers were the most common alternatives. Only 1 alternative appeared to increase prescriber acceptance: role tailoring. Possible reasons include the importance of etiquette in delivering advice, the cognitive benefits of delegation, and the difficulties of computing "relevance." CONCLUSIONS Alert fatigue may be mitigated by redesigning the interactive behavior of CDS and tailoring CDS to clinical roles. Further research is needed to develop alternative designs, and to standardize measurement methods to enable meta-analyses.
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Affiliation(s)
- Mustafa I Hussain
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| | - Tera L Reynolds
- Department of Informatics, University of California, Irvine, Irvine, California, USA
| | - Kai Zheng
- Department of Informatics, University of California, Irvine, Irvine, California, USA
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6
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Chuang TJ, Wang YH, Wei JCC, Yeh CJ. Association Between Use of Anti-gout Preparations and Dementia: Nested Case-Control Nationwide Population-Based Cohort Study. Front Med (Lausanne) 2021; 7:607808. [PMID: 33511144 PMCID: PMC7835136 DOI: 10.3389/fmed.2020.607808] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/07/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives: Gout is the most common form of inflammatory arthritis and was found to be independently associated with incident dementia in the elderly. However, the associations between anti-gout preparations and dementia were not well-studied. Methods: Data were collected from Taiwan's National Health Insurance Research Database (NHIRD). A 2005–2013 retrospective cohort study was conducted, and all investigated subjects were identified by International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Clinical Modification. Conditional logistic regression was used to evaluate the odds ratio of dementia in relation to different gout preparations (benzbromarone, allopurinol, sulfinpyrazone, probenecid) and number of days of anti-gout preparation use, after adjustment for potential confounding variables. Results: A total of 3,242 gout patients with and without dementia were selected from the NHIRD and included in the final analysis after 1:1 matching for age, gender, and diagnosis year of gout. In the anti-gout preparations, only use of Benzbromarone decreased the risk of dementia (adjusted OR, 0.81; 95% CI, 0.68–0.97). The result of the subgroup analysis revealed a trend toward a lower risk of dementia with longer use of benzbromarone. Use of benzbromarone for ≥180 days showed a significantly lower risk of dementia (adjusted OR, 0.72; 95% CI, 0.58–0.89). Moreover, the protective effect was more pronounced in males compared with females. Conclusion: This cohort study reveals that gout patients taking benzbromarone are at a decreased risk of developing incident dementia, especially with longer use and in male. Further prospective trials are warranted to confirm our findings.
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Affiliation(s)
- Tsung-Ju Chuang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, National Defense Medical Center, Taichung Armed Forces General Hospital, Taichung, Taiwan.,School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Department of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan.,Institute of Medicine, College of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Chih-Jung Yeh
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
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7
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Kruse CS, Kindred B, Brar S, Gutierrez G, Cormier K. Health Information Technology and Doctor Shopping: A Systematic Review. Healthcare (Basel) 2020; 8:E306. [PMID: 32872211 PMCID: PMC7551569 DOI: 10.3390/healthcare8030306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 01/13/2023] Open
Abstract
Doctor shopping is the practice of visiting multiple physicians to obtain multiple prescriptions. Health information technology (HIT) allows healthcare providers and patients to leverage records or shared information to improve effective care. Our research objective was to determine how HIT is being leveraged to control for doctor shopping. We analyzed articles that covered a 10-year time period from four databases and reported using preferred reporting items for systematic reviews and meta-analysis (PRISMA). We compared intervention, study design, and bias, in addition to showing intervention interactions with facilitators, barriers, and medical outcomes. From 42 articles published from six countries, we identified seven interventions, five facilitator themes with two individual observations, three barrier themes with six individual observations, and two medical outcome themes with four individual observations. Multiple HIT mechanisms exist to control for doctor shopping. Some are associated with a decrease in overdose mortality, but access is not universal or compulsory, and data sharing is sporadic. Because shoppers travel hundreds of miles in pursuit of prescription drugs, data sharing should be an imperative. Research supports leveraging HIT to control doctor shopping, yet without robust data sharing agreements, the efforts of the system are limited to the efforts of the entity with the least number of barriers to their goal. Shoppers will seek out and exploit that organization that does not require participation or checking of prescription drug monitoring programs (PDMP), and the research shows that they will drive great distances to exploit this weakest link.
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Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX 78666, USA; (B.K.); (S.B.); (G.G.); (K.C.)
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8
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Kan WC, Kuo SC, Chien TW, Lin JCJ, Yeh YT, Chou W, Chou PH. Therapeutic Duplication in Taiwan Hospitals for Patients With High Blood Pressure, Sugar, and Lipids: Evaluation With a Mobile Health Mapping Tool. JMIR Med Inform 2020; 8:e11627. [PMID: 32716306 PMCID: PMC7418019 DOI: 10.2196/11627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 03/06/2019] [Accepted: 03/23/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Cardiovascular disease causes approximately half of all deaths in patients with type 2 diabetes. Duplicative prescriptions of medication in patients with high blood pressure (hypertension), high blood sugar (hyperglycemia), and high blood lipids (hyperlipidemia) have attracted substantial attention regarding the abuse of health care resources and to implement preventive measures for such abuse. Duplicative prescriptions may occur by patients receiving redundant medications for the same condition from two or more sources such as doctors, hospitals, and multiple providers, or as a result of the patient's wandering among hospitals. OBJECTIVE We evaluated the degree of duplicative prescriptions in Taiwanese hospitals for outpatients with three types of medications (antihypertension, antihyperglycemia, and antihyperlipidemia), and then used an online dashboard based on mobile health (mHealth) on a map to determine whether the situation has improved in the recent 25 fiscal quarters. METHODS Data on duplicate prescription rates of drugs for the three conditions were downloaded from the website of Taiwan's National Health Insurance Administration (TNHIA) from the third quarter of 2010 to the third quarter of 2016. Complete data on antihypertension, antihyperglycemia, and antihyperlipidemia prescriptions were obtained from 408, 414, and 359 hospitals, respectively. We used scale quality indicators to assess the attributes of the study data, created a dashboard that can be traced using mHealth, and selected the hospital type with the best performance regarding improvement on duplicate prescriptions for the three types of drugs using the weighted scores on an online dashboard. Kendall coefficient of concordance (W) was used to evaluate whether the performance rankings were unanimous. RESULTS The data quality was found to be acceptable and showed good reliability and construct validity. The online dashboard using mHealth on Google Maps allowed for easy and clear interpretation of duplicative prescriptions regarding hospital performance using multidisciplinary functionalities, and showed significant improvement in the reduction of duplicative prescriptions among all types of hospitals. Medical centers and regional hospitals showed better performance with improvement in the three types of duplicative prescriptions compared with the district hospitals. Kendall W was 0.78, indicating that the performance rankings were not unanimous (Chi square2=4.67, P=.10). CONCLUSIONS This demonstration of a dashboard using mHealth on a map can inspire using the 42 other quality indicators of the TNHIA by hospitals in the future.
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Affiliation(s)
- Wei-Chih Kan
- Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Shu-Chun Kuo
- Department of Ophthalmology, Chi Mei Medical Center, Tainan, Taiwan.,Department of Optometry, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | | | | | - Yu-Tsen Yeh
- Medical School, St George's, University of London, London, United Kingdom
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chiali Chi Mei Hospital, Tainan, Taiwan.,Department of Physical Medicine and Rehabilitation, Chung Shan Medical University, Taichung, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Wu CF, Li F, Hsueh HP, Wang CM, Lin MC, Chang T. A Dynamic Relationship between Environmental Degradation, Healthcare Expenditure and Economic Growth in Wavelet Analysis: Empirical Evidence from Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041386. [PMID: 32098090 PMCID: PMC7068420 DOI: 10.3390/ijerph17041386] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 12/31/2022]
Abstract
This paper analyzes the co-movement and causal linkages between environmental pollution and healthcare expenditure, taking economic growth as a control variable by using wavelet analysis for Taiwan over the period 1995 Q1-2016 Q4. The results show that there exists co-movement and causality between environmental pollution and healthcare expenditure at different frequencies and times. The changes in the relationships of the two variables are observed in certain events such as the period of the expansion stage, the policy of environmental pollution, and the issue of the National Health Insurance Integrated Circuit card (NHI-IC) in Taiwan. In the short-term, positive causality runs from healthcare expenditure to environmental pollution before 2004, while negative causality runs from healthcare expenditure to environmental pollution before 2007 in the long-term. After adding economic growth as a control variable, positive causality runs from healthcare expenditure to environmental pollution in the period 2009-2011 in the short-term, while negative causality running from healthcare expenditure to environmental pollution is shown in 2008 in the long-term. The results indicate that "higher government health expenditure leading to higher demand for environment quality" exists in different sub-periods and the argument may concern the factor of economics in the long-term. The positive healthcare lead in the short-term may be based on economics in the expansion stage. Also, the issue of NHI-IC possibly affects the dynamic relationship between healthcare expenditure and environmental pollution without considering economics. Based on empirical analysis, certain policy and managerial implications are addressed for decision-makers at macroeconomic and microeconomic levels.
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Affiliation(s)
- Cheng-Feng Wu
- School of Business Administration, Hubei University of Economics, Wuhan 430205, China; (C.-F.W.); (M.-C.L.)
- Research Center of Hubei Logistics Development, Hubei University of Economics, Wuhan 430205, China
| | - Fangjhy Li
- Department of Finance, School of Finance, Hubei University of Economics, Wuhan 430205, China;
| | - Hsin-Pei Hsueh
- School of Finance, Hubei University of Economics, Wuhan 430205, China;
| | - Chien-Ming Wang
- School of Economics and Trade, Hubei University of Economics, Wuhan 430205, China
- Correspondence:
| | - Meng-Chen Lin
- School of Business Administration, Hubei University of Economics, Wuhan 430205, China; (C.-F.W.); (M.-C.L.)
| | - Tsangyao Chang
- Department of Finance, School of Finance, Feng Chia University, Taichung 40724, Taiwan;
- CTBC Business School, Tainan 709, Taiwan
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10
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Tsai TL, Wei JCC, Wu YT, Ku YH, Lu KL, Wang YH, Chiou JY. The Association Between Usage of Colchicine and Pneumonia: A Nationwide, Population-Based Cohort Study. Front Pharmacol 2019; 10:908. [PMID: 31474864 PMCID: PMC6706461 DOI: 10.3389/fphar.2019.00908] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 12/22/2022] Open
Abstract
Objectives: A previous study suggested that colchicine may cause leukopenia and increase the risk of infection, such as pneumonia. Thus, we investigated the potential relationship between colchicine use and risk of developing pneumonia. Methods: Data were collected from Taiwan's National Health Insurance Research Database (NHIRD), a nationwide, population-based database. A 13-year retrospective cohort study was conducted, and all investigated subjects were identified by International Classification of Disease, Ninth Revision, Clinical Modification, codes between 2000 and 2012. Propensity score matching was applied to adjust for potential confounding variables, and then Cox proportional hazard model was used to evaluate the hazard ratio (HR) of pneumonia in gout patients and its associations with colchicine use, colchicine dosage, and days of colchicine use. Results: A total of 24,410 gout patients were enrolled in this study, including 12,205 cases who were treated with colchicine (colchicine group) and 12,205 cases who did not receive colchicine (non-colchicine group). The overall incidence rates of pneumonia in the colchicine group and non-colchicine group were 18.6 and 12.6 per 1,000 person-years, respectively. The colchicine group had a higher risk of pneumonia as compared with the non-colchicine group [adjusted HR, 1.42; 95% confidence interval (CI), 1.32 to 1.53; P < 0.05]. High cumulative dose and days of colchicine use notably increased the risk of contracting pneumonia. Conclusion: This nationwide population-based cohort study reveals that gout patients taking colchicine are at increased risk of developing pneumonia compared with gout patients who do not use colchicine. Therefore, it is crucial that gout patients being treated with colchicine be given the minimally effective dosage for the shortest possible duration to minimize their risk of pneumonia.
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Affiliation(s)
- Tsung-Lin Tsai
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| | - Yue-Ting Wu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yueh-Han Ku
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Kun-Lin Lu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
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11
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Regulatory effect of decreasing therapeutic duplication of respiratory drugs using a prescription database between 2012 and 2015. Regul Toxicol Pharmacol 2019; 103:218-228. [DOI: 10.1016/j.yrtph.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/24/2018] [Accepted: 02/04/2019] [Indexed: 11/20/2022]
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12
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Kim JH, Park EC. Can diabetes patients seeking a second hospital get better care? Results from nested case-control study. PLoS One 2019; 14:e0210809. [PMID: 30668580 PMCID: PMC6342308 DOI: 10.1371/journal.pone.0210809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 01/02/2019] [Indexed: 12/05/2022] Open
Abstract
This study investigates the effects of the number of medical institutions visited on risk of death. This study conducted a nested case-control design using the National Health Insurance Service-Senior database from 2002 to 2013. Cases were defined as those with death among outpatients who had first diagnosis of diabetes mellitus (E10-E14) after entry into the base cohort and controls were selected by incidence density sampling and matched to cases based on age, and sex. Our main results were presented by conditional logistic regression for nested case-controls design. Of total 55,558 final study samples, there were 9,313 (16.8%) cases and 46,245 (83.2%) controls. With an increase by one point in the number of hospitals per medical utilization, risk of death significantly increased by 4.1% (odds ratio (OR): 1.041, 95% confidence interval [CI]: 1.039-1.043). In both medical utilization and number of hospitals, those with high medical utilization (OR: 1.065, 95% CI: 1.059-1.070) and number of hospitals (OR: 1.049, 95% CI: 1.041-1.058) for risk of death were significantly higher than those with low medical utilization (OR: 1.040, 95% CI: 1.037-1.043) and number of hospitals (OR: 1.029, 95% CI: 1.027-1.032), respectively. The number of medical institution visited was significantly associated with risk of death. Therefore, diabetics should be warned about the potential of risk of death incurred from excessive access to medical utilizations.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Republic of Korea
- Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Biernikiewicz M, Taieb V, Toumi M. Characteristics of doctor-shoppers: a systematic literature review. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2019; 7:1595953. [PMID: 30956784 PMCID: PMC6442108 DOI: 10.1080/20016689.2019.1595953] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/07/2019] [Accepted: 03/11/2019] [Indexed: 05/17/2023]
Abstract
Objective: Doctor-shopping has significant consequences for patients and payers and can indicate misuse of drugs, polypharmacy, less continuity of care, and increased medical expenses. This study reviewed the literature describing doctor-shoppers in the adult population. Methods: A systematic literature review was performed in PubMed and supplemented by a Google search of grey literature. Overall, 2885 records were identified; 43 papers served as a source of definition of a doctor-shopper, disease, treatment, patient characteristics, patient special needs, country. Results: Definitions of doctor-shopping were heterogeneous. Overall, 40% of studies examined the use of opioids, antidepressants, or psychoactive drugs, while the others focused on chronic or frequent diseases. Most studies were conducted in countries with easy access to healthcare resources (USA, France, Taiwan, Hong Kong). The prevalence of doctor-shopping ranged from 0.5% among opioid users in the USA to 25% of patients registered at general practices in Japan. Comorbidities, active substance abuse, greater distance from healthcare facility, younger age, longer disease and poor patient satisfaction increased doctor-shopping. Conclusions: Knowing the characteristics of doctor-shoppers may help identify such patients and reduce the associated waste of medical resources, but concerns about the misuse of drugs or healthcare resources should not prevent proper disease management.
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Affiliation(s)
- Małgorzata Biernikiewicz
- Medical Writing and Publishing Department, Creativ-Ceutical, Cracow, Poland
- CONTACT Małgorzata Biernikiewicz Creativ-Ceutical, ul. Przemysłowa 12, Krakow30-701, Poland
| | - Vanessa Taieb
- HEOR Department, Evidence Synthesis Team, Creativ-Ceutical, London, UK
| | - Mondher Toumi
- Faculty of Medicine, Aix-Marseille University, Marseilles, France
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Wang MH, Lu TH, Huang WN, Yeh YT. Intelligent prescription system combined with a national pharmacloud for geriatrics care. Expert Rev Pharmacoecon Outcomes Res 2018; 18:559-564. [PMID: 29939812 DOI: 10.1080/14737167.2018.1492912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The elderly are high risk for chronic diseases and multiple drug use - two problems that make geriatric medication use more complex; as a result, the possibility of duplicate prescriptions and drug interactions increase, affecting patient safety. The objective of this study was to develop an Intelligent Prescription System Combined with a National PharmaCloud for Geriatrics Care (IPSPcG) that can reduce the occurrence of duplicate prescriptions. METHODS The system was implemented in a teaching hospital in Taiwan. The IPSPcG consists of two major components: (1) the collection module and (2) Intelligent Knowledge-base Module. Data on medication prescription behaviors and medication-blocking rates were gathered from January 2015 to December 2017. RESULTS Overall, during the study period, the IPSPcG system included 39,678 prescriptions. Antihypertensive medications were included at the highest proportion (8962, 22.6%). The system changed physician's prescription behavior (p < .001) and decreased potential duplicate prescription times (14%). CONCLUSION The results of this study show that integrating appropriate recommendations from drug messages can reduce repeated drug prescriptions. Due to the diversity of diseases, the diversity and accuracy of medical advice must improve. The results of the 'Comprehensive Prescription Information' provided by this system can serve as a reference for future research.
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Affiliation(s)
- Mei-Hua Wang
- a Graduate Institute of Biomedical Informatics, College of Medical Science and Technology , Taipei Medical University , Taipei City , Taiwan
| | - Tzu-Hsuan Lu
- b Medical Quality Department, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
| | - Wei-Ni Huang
- c Information Technology Office, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
| | - Yu-Ting Yeh
- a Graduate Institute of Biomedical Informatics, College of Medical Science and Technology , Taipei Medical University , Taipei City , Taiwan.,c Information Technology Office, Shuang Ho Hospital , Taipei Medical University , New Taipei City , Taiwan
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15
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Yang CY, Lo YS, Chen RJ, Liu CT. A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation. JMIR Med Inform 2018; 6:e6. [PMID: 29351893 PMCID: PMC5797291 DOI: 10.2196/medinform.9064] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Revised: 12/23/2017] [Accepted: 12/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background A computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan. Objective This study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters. Methods A CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter. Results The CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled. Conclusions The CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the factors in increasing the PharmaCloud consent rate is required.
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Affiliation(s)
- Cheng-Yi Yang
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Medical Informatics, Industrial Technology Research Institute, Hsinchu, Taiwan
| | - Yu-Sheng Lo
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
| | - Ray-Jade Chen
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Taipei Medical University Hospital, Taipei, Taiwan
| | - Chien-Tsai Liu
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
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16
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Wang HY, Yeh MK, Ho CH, Hu MK, Huang YB. Cross-sectional investigation of drug-related problems among adults in a medical center outpatient clinic: application of virtual medicine records in the cloud. Pharmacoepidemiol Drug Saf 2016; 26:71-80. [PMID: 27730699 DOI: 10.1002/pds.4117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/13/2016] [Accepted: 09/17/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE To analyze and characterize data regarding the prevalence and types of outpatient drug-related problems (DRPs) found by clinical pharmacists after implementation of the Virtual Medicine Record in Cloud System (VMRCS). METHODS A cross-sectional study regarding outpatient pharmaceutical care was conducted at a medical center in Taiwan. Patients aged >20 years old with multiple chronic diseases and polypharmacy were enrolled. In Stage I (1 October-31 December 2014), patients received pharmaceutical care according to prescription data accessed online in the VMRCS. In Stage II (1 June-31 August 2015), the VMRCS were pre-download and arranged to the institute's required format, facilitated DRP detection. Clinical pharmacists then reviewed and evaluated the prescription data through pre-downloaded VMRCS. Overall, 1539 and 1600 prescriptions were evaluated in these two stages, respectively. DRPs were recorded using the Pharmaceutical Care Network Europe (PCNE)-DRP. RESULTS DRPs were found for 50.2% of patients in Stage I and 55.2% in Stage II (p < 0.05) and were most frequently encountered for "Drugs for the cardiovascular system" and caused by "Inappropriate duplication of therapeutic group or active ingredient." In terms of problems, incidence of "Unnecessary drug treatment" was highest. Duplicate medications were most frequently seen for "Drugs for acid-related disorders." The efficiency to identify DRPs was at least 2.4 times higher with pre-downloaded prescription data than with real-time online queries. CONCLUSIONS With VMRCS, DRPs were more easily identified whether patients received medical care in the same hospital or not. DRPs could be efficiently prevented through the use of pre-downloaded patient prescription data. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Hue-Yu Wang
- Department of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan.,College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Kung Yeh
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan.,Taipei Hospital, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chung-Han Ho
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.,Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Kuan Hu
- School of Pharmacy, Graduate Institute of Medical Science, National Defense Medical Center, Taiwan
| | - Yaw-Bin Huang
- College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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17
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Social network analysis of duplicative prescriptions: One-month analysis of medical facilities in Japan. Health Policy 2016; 120:334-41. [DOI: 10.1016/j.healthpol.2016.01.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 01/16/2016] [Accepted: 01/22/2016] [Indexed: 11/22/2022]
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18
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Effects of Shared Electronic Health Record Systems on Drug-Drug Interaction and Duplication Warning Detection. BIOMED RESEARCH INTERNATIONAL 2015; 2015:380497. [PMID: 26682218 PMCID: PMC4670632 DOI: 10.1155/2015/380497] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/08/2015] [Accepted: 10/18/2015] [Indexed: 11/18/2022]
Abstract
Shared electronic health records (EHRs) systems can offer a complete medication overview of the prescriptions of different health care providers. We use health claims data of more than 1 million Austrians in 2006 and 2007 with 27 million prescriptions to estimate the effect of shared EHR systems on drug-drug interaction (DDI) and duplication warnings detection and prevention. The Austria Codex and the ATC/DDD information were used as a knowledge base to detect possible DDIs. DDIs are categorized as severe, moderate, and minor interactions. In comparison to the current situation where only DDIs between drugs issued by a single health care provider can be checked, the number of warnings increases significantly if all drugs of a patient are checked: severe DDI warnings would be detected for 20% more persons, and the number of severe DDI warnings and duplication warnings would increase by 17%. We show that not only do shared EHR systems help to detect more patients with warnings but DDIs are also detected more frequently. Patient safety can be increased using shared EHR systems.
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19
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Heinze G, Jandeck LM, Hronsky M, Reichardt B, Baumgärtel C, Bucsics A, Müllner M, Winkelmayer WC. Prevalence and determinants of unintended double medication of antihypertensive, lipid-lowering, and hypoglycemic drugs in Austria: a nationwide cohort study. Pharmacoepidemiol Drug Saf 2015; 25:90-9. [DOI: 10.1002/pds.3898] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 09/07/2015] [Accepted: 09/22/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Lisanne M. Jandeck
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Milan Hronsky
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems; Medical University of Vienna; Vienna Austria
| | - Berthold Reichardt
- Sickness Fund Burgenland; Burgenländische Gebietskrankenkasse; Eisenstadt Austria
| | | | - Anna Bucsics
- Main Association of the Austrian Social Security Institutions; Vienna Austria
- Department of Finance; University of Vienna; Vienna Austria
| | - Marcus Müllner
- Austrian Agency for Health and Food Safety; Vienna Austria
- PERI Change GmbH; Vienna Austria
| | - Wolfgang C. Winkelmayer
- Division of Nephrology; Stanford University School of Medicine; Palo Alto CA USA
- Section of Nephrology, Department of Medicine; Baylor College of Medicine; Houston TX USA
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20
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NHI-PharmaCloud in Taiwan—A preliminary evaluation using the RE-AIM framework and lessons learned. Int J Med Inform 2015; 84:817-25. [DOI: 10.1016/j.ijmedinf.2015.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 05/28/2015] [Accepted: 06/01/2015] [Indexed: 11/20/2022]
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21
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Lin MH, Chang HT, Tu CY, Chen TJ, Hwang SJ. Doctor-Shopping Behaviors among Traditional Chinese Medicine Users in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9237-47. [PMID: 26262631 PMCID: PMC4555276 DOI: 10.3390/ijerph120809237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/30/2015] [Accepted: 08/04/2015] [Indexed: 11/16/2022]
Abstract
Doctor-shopping has caused an increase in medical expense, potential to receive duplicate medications, and suffer adverse drug reactions. We carried out a population-based retrospective study aimed at examining the user patterns of traditional Chinese medicine (TCM) ambulatory care in Taiwan. We retrieved complete TCM ambulatory visit datasets for the year 2007 from the National Health Insurance database in Taiwan. We defined the patients whose distribution of TCM physician numbers scored more than 97.5 percent (more than, or equal to, five TCM physicians) within one year as TCM doctor-shoppers. In total, 6,596,814 subjects (28.9%) paid TCM visits during that year. All 177,728 subjects (2.69%) who visited more than five (including) TCM physicians were classified as TCM shoppers. The most prevalent diagnostic grouping was upper respiratory infections (44.7%) and sprains and strains (44.0%). Men had a lower odds ratio (OR) among TCM shoppers than women (OR = 0.94, 95% confidence interval (CI) = 0.93-0.96). Younger people were less likely to be TCM shoppers than other people were. The ORs of TCM shoppers were higher among veterans and low-income patients (OR = 1.29 (1.23-1.35), and 1.33 (1.27-1.41)). In conclusion, health education on the potential of drug interactions and iatrogenic health risks incurred from doctor-shopping should be addressed to those high-risk patients.
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Affiliation(s)
- Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Chun-Yi Tu
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
- Department of Family Medicine, Taipei Veterans General Hospital, Taoyuan branch, No. 100, Sec. 3, Cheng-Kung Road, Tao-Yuan 330, Taiwan.
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shi-Pai Road, Taipei 112, Taiwan.
- School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan.
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Wu MH, Wu MJ, Chou LF, Chen TJ. Patterns of nonemergent visits to different healthcare facilities on the same day: a nationwide analysis in Taiwan. ScientificWorldJournal 2014; 2014:627580. [PMID: 24892063 PMCID: PMC4032646 DOI: 10.1155/2014/627580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 04/02/2014] [Indexed: 11/20/2022] Open
Abstract
Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010) of Taiwan's National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n = 212,590) of all switches occurred between facilities of the same accreditation level, 14.1% (n = 47,664) moved from lower to higher level, and 22.8% (n = 77,006) moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148) and diseases of the respiratory system (10,393). In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.
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Affiliation(s)
- Meng-Hsuan Wu
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
| | - Meng-Ju Wu
- Faculty of Medicine, Semmelweis University, Budapest 1094, Hungary
| | - Li-Fang Chou
- Department of Public Finance, National Chengchi University, Taipei 116, Taiwan
| | - Tzeng-Ji Chen
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
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Detection of potential drug-drug interactions for outpatients across hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1369-83. [PMID: 24473112 PMCID: PMC3945543 DOI: 10.3390/ijerph110201369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 01/13/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Abstract
The National Health Insurance Administration (NHIA) has adopted smart cards (or NHI-IC cards) as health cards to carry patients' medication histories across hospitals in Taiwan. The aims of this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient's medication history stored in his/her NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operation on NHI-IC cards. Based on analysis of the transaction tracking log from 1 August to 31 October 2007, physicians read patients' NHI-IC cards in 71.01% (8,246) of patient visits; 33.02% (2,723) of the card reads showed at least one medicine currently being taken by the patient, 82.94% of which were prescribed during the last visit. Among 10,036 issued prescriptions, seven prescriptions (0.09%) contained at least one drug item that might interact with the currently-taken medicines stored in NHI-IC cards and triggered pop-up alerts. This study showed that the capacity of an NHI-IC card is adequate to support DDI checking across hospitals. Thus, the enhanced computerized physician order entry (CPOE) system can support better DDI checking when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.
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Sellappans R, Chua SS, Tajuddin NAA, Mei Lai PS. Health innovation for patient safety improvement. Australas Med J 2013; 6:60-3. [PMID: 23423150 DOI: 10.4066/amj.2013.1643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Medication error has been identified as a major factor affecting patient safety. Many innovative efforts such as Computerised Physician Order Entry (CPOE), a Pharmacy Information System, automated dispensing machines and Point of Administration Systems have been carried out with the aim of improving medication safety. However, areas remain that require urgent attention. One main area will be the lack of continuity of care due to the breakdown of communication between multiple healthcare providers. Solutions may include consideration of "health smart cards" that carry vital patient medical information in the form of a "credit card" or use of the Malaysian identification card. However, costs and technical aspects associated with the implementation of this health smart card will be a significant barrier. Security and confidentiality, on the other hand, are expected to be of primary concern to patients. Challenges associated with the implementation of a health smart card might include physician buy-in for use in his or her everyday practice. Training and technical support should also be available to ensure the smooth implementation of this system. Despite these challenges, implementation of a health smart card moves us closer to seamless care in our country, thereby increasing the productivity and quality of healthcare.
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Affiliation(s)
- Renukha Sellappans
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG)
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