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Rudoler D, Austin N, Allin S, Bjerre LM, Dolovich L, Glazier RH, Grudniewicz A, Laporte A, Martin E, Schultz S, Sirois C, Strumpf E. The impact of team-based primary care on medication-related outcomes in older adults: A comparative analysis of two Canadian provinces. Prev Med Rep 2023; 36:102512. [PMID: 38116285 PMCID: PMC10728440 DOI: 10.1016/j.pmedr.2023.102512] [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: 04/14/2023] [Revised: 09/29/2023] [Accepted: 11/08/2023] [Indexed: 12/21/2023] Open
Abstract
Objective To evaluate if access to team-based primary care is related to medication management outcomes for older adults. Methods We completed two retrospective cohort studies using administrative health data for older adults (66+) in Ontario (n = 428,852) and Québec (n = 310,198) who were rostered with a family physician (FP) between the 2001/02 and 2017/18 fiscal years. We generated matched comparison groups of older adults rostered to an FP practicing in a team-based model, and older adults rostered to an FP in a non-team model. We compared the following outcomes between these groups: any adverse drug reactions (ADRs), any potentially inappropriate prescription (PIP), and polypharmacy. Average treatment effects of access to team-based care were estimated using a difference-in-differences estimator. Results The risk of an ADR was 22 % higher (RR = 1.22, 95 % CI = 1.18, 1.26) for older adults rostered to a team-based FP in Québec and 6 % lower (RR = 0.943, 95 % CI = 0.907, 0.978) in Ontario. However, absolute risk differences were less than 0.5 %. Differences in the risk of polypharmacy were small in Québec (RR = 1.005, 95 % CI = 1.001, 1.009) and Ontario (RR = 1.004, 95 % CI = 1.001, 1.007) and had absolute risk differences of less than 1 % in both provinces. Effects on PIP were not statistically or clinically significant in adjusted models. Interpretation We did not find evidence that access to team-based primary care in Ontario or Québec meaningfully improved medication management outcomes for older adults.
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Affiliation(s)
- David Rudoler
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Nichole Austin
- School of Health Administration, Dalhousie University, Halifax, Canada
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lise M. Bjerre
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Richard H. Glazier
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Audrey Laporte
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
| | - Elisabeth Martin
- Faculty of Nursing Sciences, Université Laval, Québec City, Québec, Canada
| | | | - Caroline Sirois
- Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
| | - Erin Strumpf
- Canadian Centre for Health Economics, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Economics, McGill University, Montréal, Québec, Canada
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2
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Austin N, Rudoler D, Allin S, Dolovich L, Glazier RH, Grudniewicz A, Martin E, Sirois C, Strumpf E. Team-based primary care reforms and older adults: a descriptive assessment of sociodemographic trends and prescribing endpoints in two Canadian provinces. BMC PRIMARY CARE 2023; 24:7. [PMID: 36627566 PMCID: PMC9832790 DOI: 10.1186/s12875-022-01960-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 12/27/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Team-based primary care reforms aim to improve care coordination by involving multiple interdisciplinary health professionals in patient care. Team-based primary care may support improved medication management for older adults with polypharmacy and multiple points of contact with the healthcare system. However, little is known about this association. This study compares sociodemographic and prescribing trends among older adults in team-based vs. traditional primary care models in Ontario and Quebec. METHODS We constructed two provincial cohorts using population-level health administrative data from 2006-2018. Our primary exposure was enrollment in a team-based model of care. Key endpoints included adverse drug events (ADEs), potentially inappropriate prescriptions (PIPs), and polypharmacy. We plotted prescribing trends across the observation period (stratified by model of care) in each province. We used standardized mean differences to compare characteristics of older adults and providers, as well as prescribing endpoints. RESULTS Formal patient/physician enrollment increased in both provinces since the time of policy implementation; team-based enrollment among older adults was higher in Quebec (47%) than Ontario (33%) by the end of our observation period. The distribution of sociodemographic characteristics was reasonably comparable between team-based and non-team-based patients in both provinces, aside from a persistently higher share of rural patients in team-based care. Most PIPs assessed either declined or remained relatively steady over time, regardless of model of care and province. Several PIPs were more common among team-based patients than non-team-based patients, particularly in Quebec. We did not detect notable trends in ADEs or polypharmacy in either province. CONCLUSIONS Our findings offer encouraging evidence that many PIPs are declining over time in this population, regardless of patients' enrollment in team-based care. Rates of decline appear similar across models of care, suggesting these models may not meaningfully influence prescribing endpoints. Additional efforts are needed to understand the impact of team-based care among older adults and improve primary care prescribing practices.
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Affiliation(s)
- Nichole Austin
- grid.55602.340000 0004 1936 8200Dalhousie University, Halifax, Canada
| | - David Rudoler
- grid.266904.f0000 0000 8591 5963Ontario Tech University, Oshawa, Canada ,grid.418647.80000 0000 8849 1617Institute for Clinical and Evaluative Sciences, Toronto, Canada ,grid.490416.e0000000089931637Ontario Shores Centre for Mental Health Sciences, Whitby, Canada
| | - Sara Allin
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada
| | - Lisa Dolovich
- grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada
| | - Richard H. Glazier
- grid.418647.80000 0000 8849 1617Institute for Clinical and Evaluative Sciences, Toronto, Canada ,grid.17063.330000 0001 2157 2938University of Toronto, Toronto, Canada ,grid.415502.7St. Michael’s Hospital, Toronto, Canada
| | - Agnes Grudniewicz
- grid.28046.380000 0001 2182 2255University of Ottawa, Ottawa, Canada
| | - Elisabeth Martin
- grid.23856.3a0000 0004 1936 8390Université Laval, Quebec City, Canada
| | - Caroline Sirois
- grid.23856.3a0000 0004 1936 8390Université Laval, Quebec City, Canada
| | - Erin Strumpf
- grid.14709.3b0000 0004 1936 8649McGill University, Montreal, Canada
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Abayateye F, Fornssler B, Feng C, D’Arcy C, Alphonsus K. Prescription drug misuse among adults in Canada: a scoping review. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2053890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Francis Abayateye
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Barb Fornssler
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Cindy Feng
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Carl D’Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Khrisha Alphonsus
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
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Bengaard AK, Iversen E, Kallemose T, Juul-Larsen HG, Rasmussen LJH, Dalhoff KP, Andersen O, Eugen-Olsen J, Houlind MB. Using soluble urokinase plasminogen activator receptor to stratify patients for medication review in the emergency department. Br J Clin Pharmacol 2021; 88:1679-1690. [PMID: 34242432 DOI: 10.1111/bcp.14982] [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: 04/07/2021] [Revised: 06/25/2021] [Accepted: 06/27/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS To investigate whether the association between levels of medication use (including polypharmacy and potentially inappropriate medications [PIMs]) and health outcomes such as readmission and mortality is dependent on baseline soluble urokinase plasminogen activator receptor (suPAR). METHODS This registry-based cohort study included medical patients admitted to the emergency department at Copenhagen University Hospital Hvidovre, Denmark. Patients were grouped according to their admission suPAR levels: low (0-3 ng/mL), intermediate (3-6 ng/mL), or high (>6 ng/mL). Hyper-polypharmacy was defined as ≥10 prescribed medications. PIMs were identified based on the EU(7)-PIM list, and data on admissions and mortality were obtained from national registries. Risk of 90-day readmission and mortality was assessed by Cox regression analysis adjusted for sex, age and Charlson comorbidity index. Results were reported as hazard ratios within 90 days of index discharge. RESULTS In total, 26 291 patients (median age 57.3 y; 52.7% female) were included. Risk of 90-day readmission and mortality increased significantly for patients with higher suPAR or higher number of medications. Among patients with low suPAR, patients with ≥10 prescribed medications had a hazard ratio of 2.41 (95% confidence interval = 2.09-2.78) for 90-day readmission and 8.46 (95% confidence interval = 2.53-28.28) for 90-day mortality compared to patients with 0 medications. Patients with high suPAR generally had high risk of readmission and mortality, and the impact of medication use was less pronounced in this group. Similar, but weaker, association patterns were observed between suPAR and PIMs. CONCLUSION The association between levels of medication use and health outcomes is dependent on baseline suPAR.
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Affiliation(s)
- Anne Kathrine Bengaard
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esben Iversen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Line Jee Hartmann Rasmussen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Psychology and Neuroscience, Duke University, Durham, North Carolina, USA
| | - Kim Peder Dalhoff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Pharmacology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Emergency Department, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Jesper Eugen-Olsen
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Morten Baltzer Houlind
- Department of Clinical Research, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark.,The Capital Region Pharmacy, Herlev, Denmark.,Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Allin S, Martin E, Rudoler D, Church Carson M, Grudniewicz A, Jopling S, Strumpf E. Comparing public policies impacting prescribing and medication management in primary care in two Canadian provinces. Health Policy 2021; 125:1121-1130. [PMID: 34176672 DOI: 10.1016/j.healthpol.2021.06.002] [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: 12/21/2020] [Revised: 05/13/2021] [Accepted: 06/04/2021] [Indexed: 10/21/2022]
Abstract
The challenges of polypharmacy and inappropriate prescribing are recognized internationally. This study synthesizes and compares the policies related to these issues introduced in Canada's two most populous provinces - Ontario and Quebec - over the first two decades of the 21st century. Drawing on policy documents and consultations with experts, we found that while medication management to address polypharmacy and inappropriate prescribing has not been an explicit and consistent policy target in either province, some policy changes sought to directly or indirectly impact medication management. These changes include the introduction of primary care teams that include pharmacists, the introduction of a medication review performed by pharmacists (in Ontario), increased emphasis on quality improvement with some attention to potentially inappropriate medications (specifically opioids in Ontario), and investments in information technology to improve communication across providers and move toward electronic prescribing to improve medication safety and appropriateness. Despite growing evidence of the problem of polypharmacy and inappropriate prescribing, there has been limited policy attention targeting these problems directly, and policy changes with potential to improve prescribing and medication management may not have been fully realized. Further research to evaluate the impact of these changes on provider behaviours, and on patient outcomes, warrants attention.
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Affiliation(s)
- Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada.
| | - Elisabeth Martin
- Faculté des sciences infirmières, Université Laval, Pavillon Ferdinand-Vandry, 1050, avenue de la Médecine - local 3645 Québec (Québec), G1V 0A6, Canada.
| | - David Rudoler
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada; Faculty of Health Sciences, Ontario Tech University, 2000 Simcoe St N, Oshawa, ON L1G 0C5, Canada.
| | - Michael Church Carson
- Department of Economics and Department of Epidemiology, Biostatistics and Occupational Health, McGill University Leacock Building, Room 418 855 Sherbrooke Street West, Montreal, QC H3A 2T7, Canada.
| | - Agnes Grudniewicz
- Telfer School of Management / École de gestion Telfer, University of Ottawa / Université d'Ottawa, 55 Laurier Ave. E, Ottawa, ON K1N 6N5, Canada.
| | - Sydney Jopling
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6, Canada
| | - Erin Strumpf
- Department of Economics and Department of Epidemiology, Biostatistics and Occupational Health, McGill University Leacock Building, Room 418 855 Sherbrooke Street West, Montreal, QC H3A 2T7, Canada
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Lin W, Haq S, Sinha S, Fan-Lun C. Impact Analysis of a Pharmacist-Led Home-Medication Review Service Within an interprofessional Outreach Team. Sr Care Pharm 2021; 36:159-170. [PMID: 33662240 DOI: 10.4140/tcp.n.2021.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the demographic and clinical characteristics of frail and homebound communitydwelling older patients receiving a home medication review (HMR) conducted by a home-visiting pharmacist; the types of drug therapy problems (DTPs) that were identified; the types of clinical interventions being recommended and their implementation rate. DESIGN Retrospective, cross-sectional chart-review study using data from patient records. SETTING Homes of patients receiving a HMR by a community pharmacy-based consulting home-visiting pharmacist. PATIENTS 171 patients received a HMR between January 1, 2016, and May 31, 2018. INTERVENTION Patients received a comprehensive HMR by a home-visiting pharmacist working as a member of an interprofessional geriatrics team. MAIN OUTCOME MEASURES Charlson Comorbidity Index (CCI) score, comorbidities, use of potentially inappropriate medications, DTPs identified, number and type of clinical interventions being recommended and successfully implemented. RESULTS Patients had a mean age of 81 years (range: 54-100 years), majority were 65 years of age or older (95%), and female (59%). Fifty-three percent of patients had a CCI score of 1 to 2, and 93.6% were experiencing multi-morbidity and polypharmacy. Patients used an average of 13.0 medications, and 76.1% were found to be using at least 1 potentially inappropriate medication. In total, the home-visiting pharmacist identified 827 DTPs and made 1088 recommendations with a successful implementation rate of 74%. CONCLUSIONS Frail and homebound communitydwelling older adults referred for a HMR were observed to be using a high number of medications with a significant number of DTPs identified. Offering HMRs was an effective method for a community-based pharmacist to make acceptable recommendations to optimize medication therapy management for frail older patients.
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Affiliation(s)
- Wuqi Lin
- 1University of Toronto, Toronto, Ontario, Canada
| | | | - Samir Sinha
- 1University of Toronto, Toronto, Ontario, Canada
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Williams M, Jordan A, Scott J, Jones M. A systematic review examining the characteristics of users of NHS patient medicines helpline services, and the types of enquiries they make. Eur J Hosp Pharm 2020; 27:323-329. [PMID: 33097614 PMCID: PMC7856156 DOI: 10.1136/ejhpharm-2019-002001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patient medicines helpline services (PMHS) are available from some National Health Service Trusts in the UK to support patients following their discharge from hospital. The aim of this systematic review was to examine the available evidence regarding the characteristics of enquirers and enquiries to PMHS, in order to develop recommendations for service improvement. METHODS Searches were conducted using Medline, Embase, Cumulative Index of Nursing and Allied Health Literature, Scopus, and Web of Science, on 4 June 2019. Forward and backward citation searches were conducted, and grey literature was searched. Studies were included if they reported any characteristics of enquirers who use PMHS, and/or enquiries received. Study quality was assessed using the Axis tool. A narrative synthesis was conducted, and where appropriate, weighted means (WMs) were calculated. Where possible, outcomes were compared with Hospital Episode Statistics (HES) data for England, to establish whether the profile of helpline users may differ to that of hospital patients. RESULTS Nineteen studies were included (~4362 enquiries). Risk of bias from assessed studies was 71%. Enquirers were predominantly female (WM=53%; HES mean=57%), elderly (WM=69 years; HES mean=53 years) and enquired regarding themselves (WM=72%). Out of inpatient and outpatient enquirers, 50% were inpatients and 50% were outpatients (WM). Six of 15 studies reported adverse effects as the main enquiry reason. Two of four studies reported antimicrobial drugs as the main enquiry drug class. From two studies, the main clinical origin of enquiries were general surgery and cardiology. Across six studies, 27% (WM) of enquiries concerned medicines-related errors. CONCLUSIONS Our findings show that PMHS are often used by elderly patients, which is important since this group may be particularly vulnerable to experiencing medicines-related issues following hospital discharge. Over a quarter of enquiries to PMHS may concern medicines-related errors, suggesting that addressing such errors is an important function of this service. However, our study findings may be limited by a high risk of bias within included studies. Further research could provide a more detailed profile of helpline users (eg, ethnicity, average number of medicines consumed), and we encourage helpline providers to use their enquiry data to conduct local projects to improve hospital services (eg, reducing errors). PROSPERO REGISTRATION NUMBER CRD42018116276.
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Affiliation(s)
- Matt Williams
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Abbie Jordan
- Department of Psychology, University of Bath, Bath, UK
| | - Jenny Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Matthew Jones
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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8
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Masnoon N, Shakib S, Kalisch Ellett L, Caughey GE. Predictors of unplanned hospitalisation in the older population: The role of polypharmacy and other medication and chronic disease-related factors. Australas J Ageing 2020; 39:e436-e446. [PMID: 32056359 DOI: 10.1111/ajag.12769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To identify demographic and medication-related predictors of unplanned hospitalisation and combine them into a hospitalisation risk score. METHODS Patients aged ≥65 years from an outpatient multimorbidity clinic were included. Hospitalisation predictors within a year of clinic discharge were identified using logistic regression. A risk score was developed. The area under the curve (AUC) was used to assess its predictive ability, compared to that of the medicines count (definition of polypharmacy). RESULTS A total of 598 patients were included (median age of 80.0 years). 58.0% (n = 347) were hospitalised within a year of clinic discharge. The AUC for the risk score incorporating age, medicines count, heart failure (HF), atherosclerotic disease and systemic steroids was 0.67 [95% CI 0.62-0.71], compared to 0.62 [95% CI 0.58-0.67] for the medicines count. CONCLUSION A hospitalisation risk score incorporating demographics, medicines, namely steroids, and diseases such as HF had increased predictive ability compared to the medicines count, providing guidance for developing future polypharmacy tools.
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Affiliation(s)
- Nashwa Masnoon
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,Department of Pharmacy, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Sepehr Shakib
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia
| | - Gillian E Caughey
- Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.,Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, SA, Australia.,School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia.,South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Rauti S, Lahtiranta J, Parisod H, Hyrynsalmi S, Salanterä S, Aromaa ME, Smed J, Leppänen V. A Proxy-Based Solution for Asynchronous Telemedical Systems. INTERNATIONAL JOURNAL OF E-HEALTH AND MEDICAL COMMUNICATIONS 2017. [DOI: 10.4018/ijehmc.2017070105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Asynchronous telemedicine systems face many challenges related to information security as the patient's sensitive information and data on medicine dosage is transmitted over a network when monitoring patients and controlling asynchronous telemedical IoT devices. This information may be modified or spied on by a malicious adversary. To make asynchronous telemedicine systems more secure, the authors present a proxy-based solution against data modification and spying attacks in web-based telemedical applications. By obfuscating the executable code of a web application and by continuously dynamically changing obfuscation, the authors' solution makes it more difficult for a piece of malware to attack its target. They use a constructive research approach. They characterize the threat and present an outline of a proposed solution. The benefits and limitations of the proposed solution are discussed. Cyber-attacks targeted at the information related to patient's care are a serious threat in today's telemedicine. If disregarded, these attacks have negative implications on patient safety and quality of care.
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Affiliation(s)
| | | | | | | | | | | | | | - Ville Leppänen
- Department of Information Technology, University of Turku, Turku, Finland
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