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Terstegen T, Niestroj C, Stangl J, Scherkl C, Morath B, Haefeli WE, Seidling HM. Approaches to medication history taking in different hospital settings: A scoping review. Am J Health Syst Pharm 2024; 81:e419-e430. [PMID: 38660785 DOI: 10.1093/ajhp/zxae112] [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: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE A comprehensive medication history can contribute to safe therapy. Many approaches aiming to improve medication history taking require significant human resources. To design an efficient process that delivers high-quality medication histories, the individual requirements and resources of a given setting need to be considered. We aimed to provide an overview of existing approaches to medication history taking and their performance in different settings to potentially support the selection of an appropriate procedure. METHODS We searched 3 literature databases (PubMed/MEDLINE, CINAHL, PsycINFO) for publications on approaches to medication history taking and analyzed them with regard to their key components as well as the setting, patient population, assessed outcomes, and efficacy. RESULTS In total, 65 publications were included and analyzed. The majority of the reported approaches relied on involvement of dedicated staff (n = 43), followed by process-oriented interventions (eg, checklists; n = 15) and information technology (IT)-guided interventions (n = 11). A mean (SD) of 6 (2.9) outcomes were described in each study. Medication discrepancies were reported in 89% of all studies, yet about 75 different descriptions of this outcome were used, making it difficult to compare study results. Only 11 studies applied a sample size calculation and statistical tests. Of those, 10 reported a positive effect of their respective intervention on the quality of medication histories. CONCLUSION Most approaches focused on pharmacy staff, which are associated with considerable cost and resources. Therefore, IT-based approaches and patient engagement should be investigated as cost-effective alternatives and tested for superiority in the same setting. Reporting guidelines and standardized methodology are needed to improve the comparability of such studies.
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Affiliation(s)
- Theresa Terstegen
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
| | | | - Julia Stangl
- Hospital Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
| | - Camilo Scherkl
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg, Germany
| | - Benedict Morath
- Hospital Pharmacy, Heidelberg University Hospital, Heidelberg, Germany
| | - Walter E Haefeli
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
| | - Hanna M Seidling
- Heidelberg University, Medical Faculty Heidelberg/Heidelberg University Hospital, Internal Medicine IX - Department of Clinical Pharmacology and Pharmacoepidemiology, Cooperation Unit Clinical Pharmacy, Heidelberg, Germany
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2
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Schwieters K, Voigt R, McDonald S, Scanlan-Hanson L, Norman B, Larson E, Garcia A, Madsen B, Rudis M, Bellolio F, Hevesi S. "Let's Chat!" Improving Emergency Department Staff Satisfaction with the Medication Reconciliation Process. West J Emerg Med 2024; 25:624-633. [PMID: 39028249 PMCID: PMC11254147 DOI: 10.5811/westjem.18324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Patients who stay in the emergency department (ED) for prolonged periods of time require verification of home medications, a process known as medication reconciliation. The complex nature of medication reconciliation can lead to adverse events and staff dissatisfaction. A multidisciplinary team was formed to improve accuracy, timing, and staff satisfaction with the medication reconciliation process. Methods Between November 2021-January 2022, stakeholders were surveyed to identify gaps in the medication reconciliation process. This project implemented education on role-specific tasks, as well as a "Let's chat!" huddle, bringing together the entire care team to perform medication reconciliation. We used real-time evaluations by frontline staff to evaluate effectiveness during plan- do-study-act cycles and obtain feedback. Following the implementation period, stakeholders completed the post-intervention survey between June-July 2022, using a 4-point Likert scale (0 = very dissatisfied to 3 = very satisfied). We calculated the change in staff satisfaction from pre-intervention to post-intervention. Differences in proportions and 95% confidence intervals are reported. This study adhered to the Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) and followed the Lean Six Sigma rapid cycle process improvement (define-measure-analyze-improve-control). Results A total of 111 front-line ED staff (physicians, nurse practitioners, physician assistants, pharmacists, nurses) completed the pre-intervention survey (of 350 ED staff, corresponding to a 31.7% response rate), and 89 stakeholders completed the post-intervention survey (a 25.4% response rate). Subjective feedback from staff identifying causes of low satisfaction with the initial process included the following: complexity of process; unclear delineation of staff roles; time burden to completion; high patient volume; and lack of standardized communication of task completion. Overall satisfaction improved after the intervention. The greatest improvement was seen in the correct medication (difference 20.7%, confidence interval [CI] 6.3-33.9%, P < 0.01), correct dose (25.6%, CI 11.4-38.6%, P < 0.001) and time last taken (24.5%, CI 11.4-37.0%, P < 0.001). Conclusion There is a steep learning curve to educate multidisciplinary staff on a new process and implement the associated changes. With goals to impact the safety of our patients and reduce negative outcomes, engagement and awareness of the team involved in the medication reconciliation process is critical to improve staff satisfaction.
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Affiliation(s)
- Kurt Schwieters
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Idaho College of Osteopathic Medicine, Meridian, Idaho
| | - Richard Voigt
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Suzette McDonald
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | | | - Breanna Norman
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Erin Larson
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic, Department of Nursing, Rochester, Minnesota
| | - Alexis Garcia
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Bo Madsen
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| | - Maria Rudis
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
- Mayo Clinic, Department of Pharmacy, Rochester, Minnesota
| | | | - Sara Hevesi
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
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3
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Kopp M, Roth JP, Geisler F, Daniel S, Ruettinger T, Treutlein C, Balbach EL, Heiss R, Wetzl M, El Amrani N, Cavallaro A, Uder M, May MS. Digitized and structured informed patient consent before contrast-enhanced computed tomography: feasibility and benefits in clinical routine. Insights Imaging 2022; 13:164. [PMID: 36219277 PMCID: PMC9554108 DOI: 10.1186/s13244-022-01304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 09/24/2022] [Indexed: 11/24/2022] Open
Abstract
Background To evaluate the feasibility and benefits of digitized informed patient consent (D-IPC) for contrast-enhanced CT and compare digitized documentation with paper-based, conventional patient records (C-PR).
Methods We offered D-IPC to 2016 patients scheduled for a CT. We assessed patient history (e.g., CT examinations, malignant or cardiovascular diseases) and contraindications (red flags) for a CT (e.g., thyroid hyperfunction, allergies) using a tablet device. We evaluated the success rate of D-IPC and compared patient age between the subgroups of patients who were able or unable to complete D-IPC. We analyzed the prevalence of marked questions and red flags (RF). RF were compared with the documentation from C-PR. We estimated greenhouse gas (GHG) emissions for paperless workflow and provide a cost–benefit analysis. Results Overall, 84.4% of patients completed D-IPC. They were younger (median 61 years) than unsuccessful patients (65 years; p < 0.001). Patients who marked questions (21.7%) were older than patients without inquiries (median 63.9 vs 59.5 years; p < 0.001). The most prevalent RF was thyroid disease (23.8%). RF were considered critical for contrast-agent injection in 13.7%, requiring personalized preparation. The detection rate for RF documented with D-IPC was higher than for C-PR (n = 385 vs. 43). GHG emissions for tablet production are 80–90 times higher than for paper production. The estimated costs were slightly higher for D-IPC (+ 8.7%).
Conclusion D-IPC is feasible, but patient age is a relevant factor. Marked questions and RF help personalize IPC. The availability of patient history by D-IPC was superior compared to C-PR.
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Affiliation(s)
- Markus Kopp
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.
| | - Jan Peter Roth
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Frederik Geisler
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Sascha Daniel
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Theresa Ruettinger
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Christoph Treutlein
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Eva L Balbach
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Rafael Heiss
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Matthias Wetzl
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany
| | - Nouhayla El Amrani
- Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.,Grenoble Alpes University, Grenoble, France
| | - Alexander Cavallaro
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Michael Uder
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
| | - Matthias S May
- Departement of Radiology, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nuremberg, 91054, Erlangen, Germany.,Imaging Science Institute, University Hospital Erlangen, Erlangen, Germany
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4
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Gionfriddo M, Hu Y, Maddineni B, Kern M, Duboski V, Kaledas WR, Elder N, Border J, Frusciante K, Kobylinski M, Wright E. Evaluation of a web-based medication reconciliation application within a primary care setting: Results from a cluster randomized controlled trial. JMIR Form Res 2022; 6:e33488. [PMID: 35023836 PMCID: PMC8941436 DOI: 10.2196/33488] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 11/25/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
Background Despite routine review of medication lists during patient encounters, patients’ medication lists are often incomplete and not reflective of actual medication use. Contributing to this situation is the challenge of reconciling medication information from existing health records, along with external locations (eg, pharmacies, other provider/hospital records, and care facilities) and patient-reported use. Advances in the interoperability and digital collection of information provides a foundation for integration of these once disparate information sources. Objective We aim to evaluate the effectiveness of and satisfaction with an electronic health record (EHR)-integrated web-based medication reconciliation application, MedTrue (MT). Methods We conducted a cluster-randomized controlled trial of MT in 6 primary care clinics within an integrated health care delivery system. Our primary outcome was medication list accuracy, as determined by a pharmacist-collected best-possible medication history (BPMH). Patient and staff perspectives were evaluated through surveys and semistructured interviews. Results Overall, 224 patients were recruited and underwent a BPMH with the pharmacist (n=118 [52.7%] usual care [UC], n=106 [47.3%] MT). For our primary outcome of medication list accuracy, 8 (7.5%) patients in the MT arm and 9 (7.6%) in the UC arm had 0 discrepancies (odds ratio=1.01, 95% CI 0.38-2.72, P=.98). The most common discrepancy identified was patients reporting no longer taking a medication (UC mean 2.48 vs MT mean 2.58, P=.21). Patients found MT easy to use and on average would highly recommend MT (average net promoter score=8/10). Staff found MT beneficial but difficult to implement. Conclusions The use of a web-based application integrated into the EHR which combines EHR, patient-reported data, and pharmacy-dispensed data did not improve medication list accuracy among a population of primary care patients compared to UC but was well received by patients. Future studies should address the limitations of the current application and assess whether improved implementation strategies would impact the effectiveness of the application.
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Affiliation(s)
- Michael Gionfriddo
- Division of Pharmaceutical, Administrative and Social Sciences, School of Pharmacy, Duquesne University, Pittsburgh, US.,Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Yirui Hu
- Department of Population Health Sciences, Geisinger, Danville, US
| | - Bhumika Maddineni
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Melissa Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Nevan Elder
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Jeffrey Border
- The Steele Institute for Health Innovation, Geisinger, Danville, US
| | - Katie Frusciante
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
| | | | - Eric Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, 100 N Academy Ave, Danville, US
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Blecker S, Adhikari S, Zhang H, Dodson JA, Desai SM, Anzisi L, Pazand L, Schoenthaler AM, Mann DM. Validation of EHR medication fill data obtained through electronic linkage with pharmacies. J Manag Care Spec Pharm 2021; 27:1482-1487. [PMID: 34595945 PMCID: PMC8759289 DOI: 10.18553/jmcp.2021.27.10.1482] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Recent linkages between electronic health records (EHRs) and pharmacy data hold opportunity for up-to-date assessment of medication adherence at the point of care. OBJECTIVE: To validate linked EHR-pharmacy data, which can be used for point-of-care interventions for concordance with insurance claims data for patients in a large health care delivery system. METHODS: We performed a retrospective cohort study of adult patients with an active antihypertensive medication order and seen as outpatients between August 25, 2019, and August 31, 2019. Pharmacy fill information was obtained from the EHR via linkages with Surescripts pharmacy and pharmacy benefit manager data, as well as from insurance claims available at our institution. We matched antihypertensive medication fills observed in the linked EHR-pharmacy database with available fills in the insurance claims database and calculated the percentage of medication fills that were available in each database. We estimated medication adherence using proportion of days covered in the linked EHR-pharmacy database and in the insurance claims database. RESULTS: Of 26,679 patients with hypertension, 23,348 (87.5%) had at least 1 antihypertensive medication fill recorded in the linked EHR-pharmacy database. Of 1,501 patients matched with the insurance database and with a documented medication fill, a fill was present for 1,484 (98.9%) and 1,259 (83.9%) patients in the linked EHR-pharmacy and insurance databases, respectively. Of 12,109 medication fills recorded in the insurance data, we found an overlap of 11,060 (91.3%) fills with the linked EHR-pharmacy database. The linked EHR-pharmacy database also contained 18,232 of 19,281 (94.6%) medication fills present in either database. Measured medication adherence was higher for patients when based on linked EHR-pharmacy data compared with insurance claims data (42% vs 30%, P < 0.001). CONCLUSIONS: Linked EHR-pharmacy data captured medication fills for the vast majority of patients and resulted in higher estimates of adherence than insurance claims. Our results suggest that pharmacy fill data available in the EHR have sufficient reliability to be used for point-of-care assessment of medication adherence. DISCLOSURES: This study was supported by grant R01HL155149 from the National Heart, Lung, and Blood Institute. Allen Thorpe provided funding for the NYU Langone Health Learning Health System Program, which helped fund this project. The authors have nothing to disclose.
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Affiliation(s)
- Saul Blecker
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
| | | | - Hanchao Zhang
- Department of Population Health, NYU School of Medicine, New York, NY
| | - John A Dodson
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
| | - Sunita M Desai
- Department of Population Health, NYU School of Medicine, New York, NY
| | - Lisa Anzisi
- NYU Network Integration, NYU Langone Health, New York, NY
| | - Lily Pazand
- Department of Managed Care, NYU Langone Health, New York, NY
| | | | - Devin M Mann
- Department of Population Health and Department of Medicine, NYU School of Medicine, New York, NY
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6
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Gholamzadeh M, Abtahi H, Ghazisaeeidi M. Applied techniques for putting pre-visit planning in clinical practice to empower patient-centered care in the pandemic era: a systematic review and framework suggestion. BMC Health Serv Res 2021; 21:458. [PMID: 33985502 PMCID: PMC8116646 DOI: 10.1186/s12913-021-06456-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022] Open
Abstract
Background One of the main elements of patient-centered care is an enhancement of patient preparedness. Thus, pre-visit planning assessment tools was emerged to prepare and involve patients in their treatment process. Objective The main objective of this article was to review the applied tools and techniques for consideration of putting pre-visit planning into practice. Methods Web of Science, Scopus, IEEE, and PubMed databases were searched using keywords from January 2001 to November 2020. The review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Then, qualitative analysis was done to suggest an appropriate framework by mapping the main concepts. Results Out of 385 citations were retrieved in initial database searches, 49 studies from ten countries were included. Applied pre-visit techniques can be classified into eight categories. Our results showed that almost 81% of studies were related to procedures that were done between each visit, while 42% of articles were related to before visits. Accordingly, the main approach of included articles was patient preparedness. While 38 studies reported this approach is effective, three studies reported the effectiveness of such tools as moderate, only two articles believed it had a low effect on improving patient-centered care. Conclusion This survey summarized the characteristics of published studies on pre-visit planning in the proposed framework. This approach could enhance the quality of patient care alongside enhancement patient-provider communication. However, such an approach can also be helpful to control pandemic diseases by reducing unnecessary referrals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06456-7.
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Affiliation(s)
- Marsa Gholamzadeh
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran
| | - Hamidreza Abtahi
- Pulmonary and Critical care Medicine Department, Thoracic Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeeidi
- Health Information Management Department, School of Allied Medical Sciences, Tehran University of Medical Sciences, 5th Floor, Fardanesh Alley, Qods Ave, Tehran, Iran.
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7
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Kopp M, Wetzl M, Geissler F, Roth JP, Wallner R, Hoefler D, Faby S, Allmendinger T, Amarteifio P, Wuest W, Cavallaro A, Uder M, May MS. Structured Digital Self-Assessment of Patient Anamnesis Prior to Computed Tomography: Performance Evaluation and Added Value. J Med Syst 2021; 45:30. [PMID: 33511485 PMCID: PMC7843739 DOI: 10.1007/s10916-020-01690-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
The aim of this study was to evaluate the performance of a tablet-based, digitized structured self-assessment (DSSA) of patient anamnesis (PA) prior to computed tomography (CT). Of the 317 patients consecutively referred for CT, the majority (n = 294) was able to complete the tablet-based questionnaire, which consisted of 67 items covering social anamnesis, lifestyle factors (e.g., tobacco abuse), medical history (e.g., kidney diseases), current symptoms, and the usability of the system. Patients were able to mark unclear questions for a subsequent discussion with the radiologist. Critical issues for the CT examination were structured and automatically highlighted as “red flags” (RFs) in order to improve patient interaction. RFs and marked questions were highly prevalent (69.5% and 26%). Missing creatinine values (33.3%), kidney diseases (14.4%), thyroid diseases (10.6%), metformin (5.5%), claustrophobia (4.1%), allergic reactions to contrast agents (2.4%), and pathological TSH values (2.0%) were highlighted most frequently as RFs. Patient feedback regarding the comprehensibility of the questionnaire and the tablet usability was mainly positive (90.9%; 86.2%). With advanced age, however, patients provided more negative feedback for both (p = 0.007; p = 0.039). The time effort was less than 20 min for 85.1% of patients, and faster patients were significantly younger (p = 0.046). Overall, the DSSA of PA prior to CT shows a high success rate and is well accepted by most patients. RFs and marked questions were common and helped to focus patients’ interactions and reporting towards decisive aspects.
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Affiliation(s)
- M Kopp
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.
| | - M Wetzl
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - F Geissler
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - J P Roth
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany
| | - R Wallner
- e.Bavarian Health GmbH, Erlangen, Germany.,Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - D Hoefler
- e.Bavarian Health GmbH, Erlangen, Germany.,Siemens Healthcare GmbH, Forchheim, Germany
| | - S Faby
- Siemens Healthcare GmbH, Forchheim, Germany
| | | | - P Amarteifio
- Siemens Healthcare GmbH, Forchheim, Germany.,Imaging Science Institute, Erlangen, Germany
| | - W Wuest
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - A Cavallaro
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M Uder
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
| | - M S May
- Departement of Radiology, University Hospital Erlangen, 91054, Erlangen, Germany.,Imaging Science Institute, Erlangen, Germany
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8
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Vest TA, Gazda NP, Schenkat DH, Eckel SF. Practice-enhancing publications about the medication-use process in 2019. Am J Health Syst Pharm 2021; 78:141-153. [PMID: 33119100 DOI: 10.1093/ajhp/zxaa355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2019 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness in promoting daily practice change. SUMMARY A PubMed search was conducted in January 2020 for calendar year 2019 using targeted Medical Subject Headings keywords; in addition, searches of the table of contents of selected pharmacy journals were conducted. A total of 4,317 articles were identified. A thorough review identified 66 potentially practice-enhancing articles: 17 for prescribing/transcribing, 17 for dispensing, 7 for administration, and 25 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice; this article assists in identifying and summarizing the most impactful recently published literature in this area. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.
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Affiliation(s)
- Tyler A Vest
- Duke University Hospital, Durham, NC.,University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC.,University of North Carolina Medical Center, Chapel Hill, NC
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9
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van der Nat DJ, Taks M, Huiskes VJB, van den Bemt BJF, van Onzenoort HAW. A comparison between medication reconciliation by a pharmacy technician and the use of an online personal health record by patients for identifying medication discrepancies in patients' drug lists prior to elective admissions. Int J Med Inform 2020; 147:104370. [PMID: 33421688 DOI: 10.1016/j.ijmedinf.2020.104370] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/16/2020] [Accepted: 12/27/2020] [Indexed: 10/22/2022]
Abstract
AIM Medication discrepancies (MDs), defined as unexplained differences among medication regimens, cause important public health problems with clinical and economic consequences. Medication reconciliation (MR) reduces the risk of MDs, but is time consuming and its success relies on the quality of different information sources. Online personalized health records (PHRs) may overcome these drawbacks. Therefore, the aim of this study is to determine the level of agreement of identified MDs between traditional MR and an online PHR and the correctness of the identified MDs with a PHR. METHODS A prospective cohort study was conducted at the cardiology, neurology, internal medicine and pulmonary department of the Amphia Hospital, the Netherlands. Two weeks prior to a planned admission all patients received an invitation from a PHR to update their medication file derived from the Nationwide Medication Record System (NMRS). At admission MR was performed with all by a pharmacy technician, who created the best possible medication history (BPMH) based on the NMRS data and an interview. MDs were determined as discrepancies between the available information from the NMRS and the input and alterations patients or pharmacy technician made. The number, correctness of patients' alterations, type and severity of identified MDs were analysed. RESULTS Of 488 patients approached, 155 (31.8 %) patients who both used the PHR and had received MR were included. The mean number of MDs identified with MR and PHR was 6.2 (SD 4.3) and 4.7 (SD 3.7), respectively. 82.1 % of the drug information noted by the patient in the PHR was correct compared to the BPMH and 98.6 % had no clinically relevant differences between the lists. CONCLUSION Patients who used an online PHR can relatively accurately record a list of their medication. Further research is required to explore the level of agreement and the correctness of a PHR in other (larger) hospital(departments).
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Affiliation(s)
| | - Margot Taks
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands
| | | | - Bart J F van den Bemt
- Department of Pharmacy, St. Maartenskliniek, Nijmegen, the Netherlands; Department of Pharmacy, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Hein A W van Onzenoort
- Department of Clinical Pharmacy, Amphia Hospital, Breda, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center+, Maastricht, the Netherlands.
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Maramba ID, Jones R, Austin D, Edwards K, Meinert E, Chatterjee A. The Role of Health Kiosks: A Scoping Review (Preprint). JMIR Med Inform 2020; 10:e26511. [PMID: 35348457 PMCID: PMC9006133 DOI: 10.2196/26511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background Health kiosks are publicly accessible computing devices that provide access to services, including health information provision, clinical measurement collection, patient self–check-in, telemonitoring, and teleconsultation. Although the increase in internet access and ownership of smart personal devices could make kiosks redundant, recent reports have predicted that the market will continue to grow. Objective We seek to clarify the current and future roles of health kiosks by investigating the settings, roles, and clinical domains in which kiosks are used; whether usability evaluations of health kiosks are being reported, and if so, what methods are being used; and what the barriers and facilitators are for the deployment of kiosks. Methods We conducted a scoping review using a bibliographic search of Google Scholar, PubMed, and Web of Science databases for studies and other publications between January 2009 and June 2020. Eligible papers described the implementation as primary studies, systematic reviews, or news and feature articles. Additional reports were obtained by manual searching and querying the key informants. For each article, we abstracted settings, purposes, health domains, whether the kiosk was opportunistic or integrated with a clinical pathway, and whether the kiosk included usability testing. We then summarized the data in frequency tables. Results A total of 141 articles were included, of which 134 (95%) were primary studies, and 7 (5%) were reviews. Approximately 47% (63/134) of the primary studies described kiosks in secondary care settings. Other settings included community (32/134, 23.9%), primary care (24/134, 17.9%), and pharmacies (8/134, 6%). The most common roles of the health kiosks were providing health information (47/134, 35.1%), taking clinical measurements (28/134, 20.9%), screening (17/134, 12.7%), telehealth (11/134, 8.2%), and patient registration (8/134, 6.0%). The 5 most frequent health domains were multiple conditions (33/134, 24.6%), HIV (10/134, 7.5%), hypertension (10/134, 7.5%), pediatric injuries (7/134, 5.2%), health and well-being (6/134, 4.5%), and drug monitoring (6/134, 4.5%). Kiosks were integrated into the clinical pathway in 70.1% (94/134) of studies, opportunistic kiosks accounted for 23.9% (32/134) of studies, and in 6% (8/134) of studies, kiosks were used in both. Usability evaluations of kiosks were reported in 20.1% (27/134) of papers. Barriers (e.g., use of expensive proprietary software) and enablers (e.g., handling of on-demand consultations) of deploying health kiosks were identified. Conclusions Health kiosks still play a vital role in the health care system, including collecting clinical measurements and providing access to web-based health services and information to those with little or no digital literacy skills and others without personal internet access. We identified research gaps, such as training needs for teleconsultations and scant reporting on usability evaluation methods.
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Affiliation(s)
| | - Ray Jones
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Daniela Austin
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Katie Edwards
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
| | - Edward Meinert
- Centre for Health Technology, University of Plymouth, Plymouth, United Kingdom
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