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Electronic Prescription

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261. The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia Full Text available with Trip Pro

The Prescription of Mobile Apps by Primary Care Teams: A Pilot Project in Catalonia In Catalonia, the Fundació TIC Salut Social's mHealth Office created the AppSalut Site to showcase to mobile apps in the field of health and social services. Its primary objective was to encourage the public to look after their health. The catalogue allows primary health care doctors to prescribe certified, connected apps, which guarantees a safe and reliable environment for their use. The generated data can (...) was voluntary.A total of 32 doctors made 79 recommendations of apps to patients. On average, the patients uploaded data 13 times per prescribed app, accounting for a total of 16 different variables. Results show that data traveled through the established channels in an adequate manner and in accordance with international standards. This includes the prescription of an app by a doctor, the patient accessing the recommendation via the PHR, app download by the patient from the official app stores, linking

2018 JMIR mHealth and uHealth

262. Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial. Full Text available with Trip Pro

with chronic musculoskeletal pain (ISRCTN 24426731).25 general practices and two community musculoskeletal services in the UK (London and Midlands).703 chronic pain participants; 81% white, 67% female, enrolled in the COPERS trial.Anonymised prescribing data over 12 months extracted from GP electronic records.Of the 703 trial participants with chronic musculoskeletal pain, 413 (59%) patients were prescribed opioids. Among those prescribed an opioid, the number of opioid prescriptions varied from 1 to 52 (...) Opioid prescribing for chronic musculoskeletal pain in UK primary care: results from a cohort analysis of the COPERS trial. To establish the level of opioid prescribing for patients with chronic musculoskeletal pain in a sample of patients from primary care and to estimate prescription costs.Secondary data analyses from a two-arm pragmatic randomised controlled trial (COPERS) testing the effectiveness of group self-management course and usual care against relaxation and usual care for patients

2018 BMJ open

263. Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project. Full Text available with Trip Pro

Enhancing system-wide implementation of opioid prescribing guidelines in primary care: protocol for a stepped-wedge quality improvement project. Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation (...) of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project.A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine

2018 BMC health services research

264. Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster randomised controlled trial. Full Text available with Trip Pro

Reducing the default dispense quantity for new opioid analgesic prescriptions: study protocol for a cluster randomised controlled trial. As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default (...) dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing.This study is a prospective cluster randomised controlled trial with two parallel arms. Primary care sites (n=32) and emergency departments (n=4) will be randomised in matched pairs to either a modification of the EHR so that new opioid analgesic prescriptions default to a dispense quantity of 10 tablets (intervention) or to no EHR change (control

2018 BMJ open Controlled trial quality: uncertain

265. Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs. Full Text available with Trip Pro

Physician Time Burden Associated with Querying Prescription Drug Monitoring Programs. Prescription drug monitoring programs (PDMPs) enable prescribers to review patient prescription histories, and their use is mandatory in many states. We estimated the cost of physicians retrieving PDMP patient reports compared with a model where a delegate (i.e., administrative staff) retrieves reports.We performed a cost analysis with a one-year time horizon, from the perspective of physicians' employers. We (...) obtained specialty-specific estimates of controlled substance prescribing frequency from the National Ambulatory Medical Care Survey, 2012-2014. We defined three PDMP usage cases based on the frequency of queries: comprehensive (before every Schedule II-IV controlled substance prescription), selective (before new Schedule II-IV prescriptions and every six months for continuing medications), and minimal (before new Schedule II or III prescriptions and annually for continuing medications).The delegate

2018 Pain Medicine

266. Education of Providers on Prescribing Best Practices

Outcome Measures : Median morphine milligram equivalents (MME) per opioid prescription [ Time Frame: 8 months ] By extracting prescribing data for opioids from the electronic health records Percentage of orders for balanced intravenous (IV) fluid solutions (i.e. not normal saline) [ Time Frame: 8 months ] By extracting prescribing data for intravenous fluids from the electronic health records Secondary Outcome Measures : Chloride levels in patients receiving intravenous fluid orders from a provider (...) health records Percent of opioid prescriptions (discharge) that also had a scheduled (not PRN) non-opioid (APAP, NSAIDs, GABA, muscle relaxant, etc.) [ Time Frame: 8 months ] By extracting medication data from the electronic health records Number of Rapid Response Team calls (RRT s) indexed to the number of patients cared for per prescriber (evaluated by level of engagement of the learner with QuizTime) [ Time Frame: 8 months ] By extracting RRT calls from the electronic health records Eligibility

2018 Clinical Trials

267. Draft Opioid-Prescribing Guidelines for Uncomplicated Normal Spontaneous Vaginal Birth. (Abstract)

Draft Opioid-Prescribing Guidelines for Uncomplicated Normal Spontaneous Vaginal Birth. Women who experience an uncomplicated vaginal delivery have acute intrapartum pain and variable pain in the immediate postpartum period. Although the Centers for Disease Control and Prevention (CDC) has urged clinicians to improve opioid-prescribing behavior, there are no published clinical practice guidelines for prescribing opioids during labor and delivery and at discharge for patients with uncomplicated (...) statistics were generated to document the characteristics of the patients receiving opioids as well as the characteristics of hospitals administering opioids during inpatient labor and delivery and on discharge. Patient-level variables included age group, marital status, race, ethnicity, payer type, and length of stay. Hospital-level variables included bed size, geographic region, teaching status, and urbanicity status. These data were then presented in an electronic Delphi survey to 14 participants

2018 Obstetrics and Gynecology

268. Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004-2015. Full Text available with Trip Pro

included if they received a lipid test at a single center (n = 58,672). Using the territory-wide electronic health record, prescribed daily statin dose, nondaily dose frequency, and statin dose intensity were determined for statin prescriptions from 2004 to 2015. Statin prescription prevalence and initiation rates were estimated using the appropriate at-risk population in the hospital catchment area as the denominator. Prescribed daily doses were stratified by primary or secondary cardiovascular (...) Trends in statin prescription prevalence, initiation, and dosing: Hong Kong, 2004-2015. Clinical practice guidelines recommend specific statin doses for the primary and secondary prevention of cardiovascular disease. Little is known about how statin utilization and dosing have evolved over time in Hong Kong. The aim of this study was to describe trends in statin prevalence, initiation, and dosing from 2004 to 2015.Patients receiving public health services, who were prescribed a statin, were

2018 Atherosclerosis

269. Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: An analysis of routine data. Full Text available with Trip Pro

Antibiotic prescribing for acute lower respiratory tract infections (LRTI) - guideline adherence in the German primary care setting: An analysis of routine data. Antibiotic overprescribing in primary care has major impacts on the development of antibiotic resistance. The objective of this study is to provide insight in antibiotics prescriptions for patients suffering from cough, acute bronchitis or community acquired pneumonia in primary care.Data from 2009 to 2013 of electronic health records (...) of 12,880 patients in Germany were obtained from a research database. The prescription of antibiotics for acute lower respiratory tract infections was compared to the national S3 guideline cough from the German Society of General Practitioners and Family Medicine.Antibiotics were prescribed in 41% of consultations. General practitioners' decision of whether or not to prescribe an antibiotic was congruent with the guideline in 52% of consultations and the antibiotic choice congruence was 51

2017 PLoS ONE

270. Setup in a clinical workflow and impact on radiotherapy routine of an in vivo dosimetry procedure with an electronic portal imaging device. Full Text available with Trip Pro

Setup in a clinical workflow and impact on radiotherapy routine of an in vivo dosimetry procedure with an electronic portal imaging device. High conformal techniques such as intensity-modulated radiation therapy and volumetric-modulated arc therapy are widely used in overloaded radiotherapy departments. In vivo dosimetric screening is essential in this environment to avoid important dosimetric errors. This work examines the feasibility of introducing in vivo dosimetry (IVD) checks (...) in a radiotherapy routine. The causes of dosimetric disagreements between delivered and planned treatments were identified and corrected during the course of treatment. The efficiency of the corrections performed and the added workload needed for the entire procedure were evaluated. The IVD procedure was based on an electronic portal imaging device. A total of 3682 IVD tests were performed for 147 patients who underwent head and neck, abdomen, pelvis, breast, and thorax radiotherapy treatments. Two types

2018 PLoS ONE

271. Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk Full Text available with Trip Pro

Increased Cardiac Sympathetic Activity and Oxidative Stress in Habitual Electronic Cigarette Users: Implications for Cardiovascular Risk Electronic cigarettes (e-cigarettes) have gained unprecedented popularity, but virtually nothing is known about their cardiovascular risks.To test the hypothesis that an imbalance of cardiac autonomic tone and increased systemic oxidative stress and inflammation are detectable in otherwise healthy humans who habitually use e-cigarettes.Cross-sectional case (...) -control study of habitual e-cigarette users and nonuser control individuals from 2015 to 2016 at the University of California, Los Angeles. Otherwise healthy habitual e-cigarette users between the ages of 21 and 45 years meeting study criteria, including no current tobacco cigarette smoking and no known health problems or prescription medications, were eligible for enrollment. Healthy volunteers meeting these inclusion criteria who were not e-cigarette users were eligible to be enrolled as control

2017 JAMA cardiology

272. Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality Full Text available with Trip Pro

Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality Potentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly.We sought to understand how the Screening Tool of Older People's Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non (...) and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced

2017 JMIR medical informatics Controlled trial quality: uncertain

273. Merging Electronic Health Record Data and Genomics for Cardiovascular Research Full Text available with Trip Pro

with the challenge of knowing which gene variants are actionable for guiding prescribing, even gene variants that may have been identified as incidental to the primary purpose of the genetic testing. The Clinical Pharmacogenetics Implementation Consortium has prioritized genes and drugs that are actionable, maintains an updated list of these genes and drugs, and has developed a number of clinical guidelines for using pharmacogenetic test results to guide prescribing, including the prescription of several (...) available in the EHR) and in the posttest state (a high-risk genetic test result is already in the EHR). In the future, interoperability of EHRs could allow genetic test results to be available at all relevant points of care, including dispensing pharmacies and outpatient clinics ( ). Figure. Current and future approaches to filling prescriptions. Genetic test results obtained from electronic health records (EHRs) could guide diagnosis and suggest drug dosages. Preemptive testing has the advantage

2016 American Heart Association

274. Electronic Health Records (EHRs)

Electronic Health Records for Continuity of Care. Methods Inf Med 2007; 46 Suppl 1: 34-46. 47 Cusack C. Electronic Health Records and Electronic Prescribing: Promise and Pitfalls. Obstet Gynecol Clin N Am 2008; 35: 63–79. 48 Baron RJ, Fabens EL, Schiffman M, Wolf E. Electronic Health Records: Just Around the Comer? Or Over the Cliff? Ann Int Med 2005; 143(3): 222-226. 49 Gagnon MP, Légaré F, Labrecque M, Frémont P, Pluye P, Gagnon J, Car J, Pagliari C, Desmartis M, Turcot L, Gravel K. Interventions (...) Electronic Health Records (EHRs) Evidence Summary: Electronic Health Records (EHRs) To the Chief Information Officer of the Champlain LHIN Prepared by the CIHR-funded Knowledge to Action research group: Sara Khangura, Jeremy Grimshaw, David Moher This report covers a broad collection of recent literature and evidence around the electronic health record (EHR). Evidence summarized from systematic reviews is highlighted in blue boxes, like this one. Systematic review evidence is generally favoured

2014 OHRI Knowledge to Action

275. Reduction of polypharmacy by electronic decision support—less is more

Reduction of polypharmacy by electronic decision support—less is more Reduction of polypharmacy by electronic decision support—less is more - The BMJ ---> Older patients with polypharmacy have become the norm rather than the exception in general practice. Treating these patients is very complex and often many specialties are involved. Keeping an overview of all drugs becomes difficult, especially in countries like Germany where the GP does not act as a gatekeeper and is not necessarily informed (...) of prescriptions made by specialist colleagues. We all know of cases where some patients are taking up to 20 different drugs regularly and we often ask ourselves if they are all really necessary. We know that this kind of polypragmatic medicine is not good for the patient. Numerous studies have shown that polypharmacy is associated with increased adverse event rates, hospitalizations, and even premature death. So there is a strong need to address the topic. All the approaches and tools that we know

2020 The BMJ Blog

276. Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? Full Text available with Trip Pro

Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? 22637768 2012 08 06 2018 11 13 1758-1095 105 5 2012 May Journal of the Royal Society of Medicine J R Soc Med Can an electronic prescribing system detect doctors who are more likely to make a serious prescribing error? 191 10.1258/jrsm.2012.120054 Kalantari Elnaz E Fayaz-Bakhsh Ahmad A eng Letter England J R Soc Med 7802879 0141-0768 IM Drug Prescriptions standards statistics & numerical (...) data Electronic Prescribing statistics & numerical data Humans Medication Errors prevention & control Practice Patterns, Physicians' Safety Management Total Quality Management 2012 5 29 6 0 2012 5 29 6 0 2012 8 7 6 0 ppublish 22637768 105/5/191-b 10.1258/jrsm.2012.120054 PMC3360530 JAMA. 2001 Dec 12;286(22):2839-44 11735759 JAMA. 1998 Apr 1;279(13):1024-9 9533503 JAMA. 2005 Mar 9;293(10):1197-203 15755942 Pediatrics. 2005 Dec;116(6):1506-12 16322178

2012 Journal of the Royal Society of Medicine

277. Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. Full Text available with Trip Pro

Effects of two commercial electronic prescribing systems on prescribing error rates in hospital in-patients: a before and after study. Considerable investments are being made in commercial electronic prescribing systems (e-prescribing) in many countries. Few studies have measured or evaluated their effectiveness at reducing prescribing error rates, and interactions between system design and errors are not well understood, despite increasing concerns regarding new errors associated with system (...) use. This study evaluated the effectiveness of two commercial e-prescribing systems in reducing prescribing error rates and their propensities for introducing new types of error.We conducted a before and after study involving medication chart audit of 3,291 admissions (1,923 at baseline and 1,368 post e-prescribing system) at two Australian teaching hospitals. In Hospital A, the Cerner Millennium e-prescribing system was implemented on one ward, and three wards, which did not receive the e

2012 PLoS medicine

278. Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes

been made for the HTA database. Citation Hall R, Khan F, O'Callaghan C, Kapral MK, Hodwitz K, Fang J, Bayley M. Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes . Toronto: Institute for Clinical Evaluative Sciences (ICES). 2012 Final publication URL Additional data URL Indexing Status Subject indexing assigned by CRD MeSH Drug Prescriptions; Electronic Prescribing; Ontarios; Stroke; Treatment Outcome Language Published English Country of organisation (...) Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Ontario stroke evaluation report 2012: prescribing system solutions to improve stroke outcomes Hall R, Khan F, O'Callaghan C, Kapral MK, Hodwitz K, Fang J, Bayley M Record Status This is a bibliographic record of a published health technology assessment. No evaluation of the quality of this assessment has

2012 Health Technology Assessment (HTA) Database.

279. Development and validation of an asthma exacerbation prediction model using electronic health record (EHR) data. (Abstract)

Development and validation of an asthma exacerbation prediction model using electronic health record (EHR) data. Objective: Asthma exacerbations are associated with significant morbidity, mortality, and cost. Accurately identifying asthma patients at risk for exacerbation is essential. We sought to develop a risk prediction tool based on routinely collected data from electronic health records (EHRs). Methods: From a repository of EHRs data, we extracted structured data for gender, race (...) , ethnicity, smoking status, use of asthma medications, environmental allergy testing BMI status, and Asthma Control Test scores (ACT). A subgroup of this population of patients with asthma that had available prescription fill data was identified, which formed the primary population for analysis. Asthma exacerbation was defined as asthma-related hospitalization, urgent/emergent visit or oral steroid use over a 12-month period. Univariable and multivariable statistical analysis was completed to identify

2019 Journal of Asthma

280. Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness. (Abstract)

Electronic Cigarette Use During a Randomized Trial of Interventions for Smoking Cessation Among Medicaid Beneficiaries with Mental Illness. Objective: People with mental illness have high rates of cigarette smoking, but many wish to quit. Electronic cigarette (e-cigarette) use has become increasingly common, especially among smokers who wish to quit, but research on whether this facilitates quitting has been mixed, and little research has examined e-cigarette use among smokers with mental (...) of prescriber visit for pharmacotherapy, behavioral interventions, and abstinence incentives; e-cigarette use was not a recommended intervention). Presence of any self-reported e-cigarette use, all tobacco product use, quit attempts, and biologically verified abstinence were assessed at 3, 6, 9, and 12 months. The 456 participants who completed the 6-month assessment were included in logistic regressions, adjusting for subject characteristics and treatment condition, examining associations between self

2019 Journal of dual diagnosis Controlled trial quality: uncertain

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