Association of adoption of medication alert systems and inappropriate prescriptions in hospital outpatient departments
Date Issued
2016
Date
2016
Author(s)
Kuo, Yu-Chun
Abstract
Background Drug safety is an important issue in health care delivery system nowadays. The Institute of Medicine (IOM) has indicated that health information technology (HIT), especially computerized physician order entry system (CPOE) embedded with clinical decision support system (CDS), can assist physicians to avoid inappropriate prescribing, reduce medication errors, and improve care quality. However, the adoption of CPOE/CDS seemed to be different among countries. Many of the previous studies which have conducted surveys on the usage of CPOE/CDS for specific alert items were limited, and only a few reports have assessed the impact or performance of CPOE/CDS. Therefore, this study aimed to understand the adoption of CPOE/CDS among hospitals, and to examine the association of CPOE/CDS adoption and inappropriate prescriptions (include medication duplication and drug-drug interaction) comprehensively in Taiwan. Material & methods In the first part of this study, a cross-sectional questionnaire was developed and mailed to 380 hospitals nationwide between July and September, 2009. The variables listed included: (1) time of adopting CPOE/CDS in the hospitals'' outpatient departments (with 6 time periods: before year 1997, 1998-2000, 2001-2003, 2004-2006, 2007-2009, 2010-2012) , (2) alert conditions and items in the CPOE/CDS, and (3) the operation status of CPOE/CDS (complexity, stability, and maintenance). In the second part, a longitudinal NHI dataset was applied to examine the association between the adoption of the CPOE/CDS system and inappropriate medication at hospital level. We evaluated two kinds of medication duplication and drug-drug interaction alert functions. The first duplicated medication was within a single prescription and was identified as ""a patient received drugs with the same therapeutic effect (as defined by level 4th of Anatomical Therapeutic Chemical system) in one prescription"", and the medication duplication rate (1) was calculated as (cases of medication duplication) / (total number of prescriptions in a hospital) x 100%. The second duplicated medication was across prescriptions and was defined as "" a patient received drugs with the same therapeutic effect in different prescriptions provided by different physicians at the same hospital within one treatment period"", and the medication duplication rate (2) was calculated as (the cases of medication duplication) / (total number of prescriptions provided in a hospital within same treatment period) x 100%. Concerning the drug-drug interaction, we only focused on the drugs for diabetes and hypertension treatment in 208 hospitals. We defined the drug-drug interaction (DDI) based on the severity level (contraindicated/major) and evidence level (excellent/good), and the DDI rate was calculated as (the cases of target DDI / total number of target prescriptions provided in a hospital). In the GEE regression models, the adoption time was classified into 6 periods: years before 1997, 1998-2000, 2001-2003, 2004-2006, 2007-2009, and 2010-2011. Hospital''s characteristics were considered in the analysis which included accreditation level, ownership, branch of NHI, the average number of drugs within one prescription, and the average age of patients in outpatient departments. Results A total of 208 hospitals completed and returned the questionnaires with a response rate of 56.8%. Adoption rate of CPOE/CDS increased from less than 10% before year 1997 to 95.83% after 2010. Most of the large-scale hospitals were early adopters and tended to implement advanced systems designed by themselves. After adjusting for related variables, medication duplication rate (1) decreased alone the time significantly (b=-2.3830 for years 1998-2000 and b=-5.5333 for years 2010-2011 with P<0.0001repectively; reference year was 1997), and medication duplication rate (2) also decreased alone the time (b=-5.58164 for 1998-2000 and b=-22.5398 for 2010-2011 with P<0.0001 respectively). However, both of diabetes and hypertension DDI rates were increased after years 2004-2006 (for DM, b=1.0271 for years 2004-2006 and b=2.0035 for 2010-2011 with P<0.0001 respectively; for hypertension, b=0.7288 for years 2004-2006 , P=0.0032 and b=1.7863 for 2010-2011, P<0.0001). Discussion and conclusion In Taiwan, hospitals introduced CPOE/CDS during 1997and 2010 and have reached 95% adoption rate. We found that medication duplication in hospitals has decreased significantly along with the development of hospital''s medication alert system. However, the drug-drug interaction was not decreasing which might be owing to the increased prevalence of chronic conditions and the NHI drug payment design. More detailed evaluation of the impact of medication alert system is needed in the future.
Subjects
medication alert system
computerized physician order entry
clinical decision support system
medication duplication
drug-drug interaction
SDGs
Type
thesis
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