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Electronic Prescription

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281. Evaluation of electronic prescription implementation in polymedicated users of Catalonia, Spain: a population-based longitudinal study. Full Text available with Trip Pro

Evaluation of electronic prescription implementation in polymedicated users of Catalonia, Spain: a population-based longitudinal study. To assess whether electronic prescribing is a comprehensive health management tool that may contribute to rational drug use, particularly in polymedicated patients receiving 16 or more medications in the public healthcare system in the Barcelona Health Region (BHR).16 months of retrospective study followed by 12 months of prospective monitoring.Primary (...) healthcare in BHR, Catalonia, Spain.All insured patients, especially those who are polymedicated in six basic health areas (BHA). Polymedicated patients were those with a consumption of ≥16 drugs/month.Monitoring demographic and consumption variables obtained from the records of prescriptions dispensed in pharmacies and charged to the public health system, as well as the resulting drug use indicators. Territorial variables related to implementation of electronic prescribing were also described and were

2014 BMJ open

282. Towards creating the perfect electronic prescription. Full Text available with Trip Pro

Towards creating the perfect electronic prescription. Significant strides have been made in electronic (e)-prescribing standards and software applications that have further fueled the adoption and use of e-prescribing. However, for e-prescribing to realize its full potential for improving the safety, effectiveness, and efficiency of prescription drug delivery, important work remains to be carried out. This perspective describes the ultimate goal of all e-prescribing stakeholders including (...) prescribers and dispensing pharmacists: a clear, complete, and unambiguous e-prescription order that can be seamlessly received, processed, and fulfilled at the dispensing pharmacy without the need for additional clarification from the prescriber. We discuss the challenges to creating the perfect e-prescription by focusing on selected data segments and data fields that are available in the new e-prescription transaction as defined in the NCPDP SCRIPT Standard and suggest steps that could be taken to move

2014 Journal of the American Medical Informatics Association

283. Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. Full Text available with Trip Pro

Unrealized potential and residual consequences of electronic prescribing on pharmacy workflow in the outpatient pharmacy. Electronic prescribing systems have often been promoted as a tool for reducing medication errors and adverse drug events. Recent evidence has revealed that adoption of electronic prescribing systems can lead to unintended consequences such as the introduction of new errors. The purpose of this study is to identify and characterize the unrealized potential and residual (...) consequences of electronic prescribing on pharmacy workflow in an outpatient pharmacy.A multidisciplinary team conducted direct observations of workflow in an independent pharmacy and semi-structured interviews with pharmacy staff members about their perceptions of the unrealized potential and residual consequences of electronic prescribing systems. We used qualitative methods to iteratively analyze text data using a grounded theory approach, and derive a list of major themes and subthemes related

2014 Journal of the American Medical Informatics Association

284. Electronic Prescribing Vulnerabilities: Height and Weight Mix-Up Leads to Dosing Error Full Text available with Trip Pro

Electronic Prescribing Vulnerabilities: Height and Weight Mix-Up Leads to Dosing Error Height and weight errors confound electronic prescribing.

2014 Pharmacy and Therapeutics

285. Assessment of legibility and completeness of handwritten and electronic prescriptions Full Text available with Trip Pro

Assessment of legibility and completeness of handwritten and electronic prescriptions To assess the legibility and completeness of handwritten prescriptions and compare with electronic prescription system for medication errors.Prospective study.King Khalid University Hospital (KKUH), Riyadh, Saudi Arabia.Handwritten prescriptions were received from clinical units of Medicine Outpatient Department (MOPD), Primary Care Clinic (PCC) and Surgery Outpatient Department (SOPD) whereas electronic (...) prescriptions were collected from the pediatric ward. The handwritten prescription was assessed for completeness by the checklist designed according to the hospital prescription and evaluated for legibility by two pharmacists. The comparison between handwritten and electronic prescription errors was evaluated based on the validated checklist adopted from previous studies.Legibility and completeness of prescriptions.398 prescriptions (199 handwritten and 199 e-prescriptions) were assessed. About 71 (35.7

2014 Saudi Pharmaceutical Journal : SPJ

286. Evaluation of a mobile electronic assistant to aid in fluindione prescription: The INRPlus cluster randomized trial. (Abstract)

Evaluation of a mobile electronic assistant to aid in fluindione prescription: The INRPlus cluster randomized trial. Regular monitoring of the international normalized ratio (INR) is crucial for dose adjustment of vitamin K antagonists (VKA) to maximize time in therapeutic range (TTR). We compared the use of a mobile electronic assistant INRPlus which proposes patient-specific fluindione doses, to standard fluindione management in a cluster randomized controlled study.Twenty clusters of six (...) % of non-compliant patients and 67.1% of reference patients.In this trial, the use of the INRPlus electronic assistant resulted in a non-significant improvement in TTR that may be due to a higher than expected TTR in the control group.Copyright © 2014 Elsevier Ltd. All rights reserved.

2014 Thrombosis research Controlled trial quality: uncertain

287. Meeting user needs in national healthcare systems: lessons from early adopter community pharmacists using the electronic prescriptions service. Full Text available with Trip Pro

Meeting user needs in national healthcare systems: lessons from early adopter community pharmacists using the electronic prescriptions service. The Electronic Prescription Service release Two (EPS2) is a new national healthcare information and communication technology in England that aims to deliver effective prescription writing, dispensing and reimbursement service to benefit patients. The aim of the study was to explore initial user experiences of Community Pharmacists (CPs) using EPS2.We (...) conducted nonparticipant observations and interviews in eight EPS2 early adopter community pharmacies classified as 'first-of-type' in midlands and northern regions in England. We interviewed eight pharmacists and two dispensers in addition to 56 hours recorded nonparticipant observations as field notes. Line-by-line coding and thematic analysis was conducted on the interview transcripts and field notes.CPs faced two types of challenge. The first was to do with missing electronic prescriptions

2014 Medical Informatics and Decision Making

288. Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. Full Text available with Trip Pro

Effect of electronic prescribing with formulary decision support on medication tier, copayments, and adherence. Medication non-adherence is prevalent. We assessed the effect of electronic prescribing (e-prescribing) with formulary decision support on preferred formulary tier usage, copayment, and concomitant adherence.We retrospectively analyzed 14,682 initial pharmaceutical claims for angiotensin receptor blocker and inhaled steroid medications among 14,410 patients of 2189 primary care (...) prescription attributed to non-adopters, low user (<30% usage rate), and high user PCPs (>30% usage rate). Second, we modeled the effect of formulary tier on prescription copayment. Last, we modeled the effect of copayment on adherence (proportion of days covered) to each new medication.Compared with non-adopters, high users of e-prescribing were more likely to prescribe preferred-tier medications (vs. non-preferred tier) when both non-interruptive and interruptive formulary decision support were in place

2014 BMC Medical Informatics and Decision Making

289. Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study). Full Text available with Trip Pro

Electronic Health Records for Intervention Research: A Cluster Randomized Trial to Reduce Antibiotic Prescribing in Primary Care (eCRT Study). This study aimed to implement a point-of-care cluster randomized trial using electronic health records. We evaluated the effectiveness of electronically delivered decision support tools at reducing antibiotic prescribing for respiratory tract infections in primary care.Family practices from England and Scotland participating in the Clinical Practice (...) with an antibiotic prescribed based on electronic health records. Family practice-specific proportions were included in a cluster-level analysis.Data were analyzed for 603,409 patients: 317,717 at intervention practices and 285,692 at control practices. Use of the intervention was less than anticipated, varying among practices. There was a reduction in proportion of consultations with antibiotics prescribed of 1.85% (95% CI, 0.10%-3.59%, P=.038) and in the rate of antibiotic prescribing for respiratory tract

2014 Annals of family medicine Controlled trial quality: uncertain

290. Adoption of electronic prescribing for controlled substances among providers and pharmacies. (Abstract)

, and the number and percentage of all pharmacies enabled for EPCS increased from 8768 (13%) to 20,498 pharmacies (30%). The proportion of all providers prescribing controlled substances electronically is currently 1%, but increasing steadily each month.There is a positive national growth for EPCS in pharmacy preparedness to accept EPCS, the number of EPCS prescriptions sent each month, and the number of providers with the ability to send EPCS. (...) Adoption of electronic prescribing for controlled substances among providers and pharmacies. Electronic prescribing for Schedule II through V controlled substances was legalized in the United States by the Drug Enforcement Administration in June 2010. However, little information exists about adoption and use of the electronic prescribing of controlled substances (EPCS) at the national level. Therefore, the objective of this study is to present the first information about national trends

2014 American Journal Of Managed Care

291. Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. Full Text available with Trip Pro

Barriers and facilitators to implementing electronic prescription: a systematic review of user groups' perceptions. We conducted a systematic review identifying users groups' perceptions of barriers and facilitators to implementing electronic prescription (e-prescribing) in primary care.We included studies following these criteria: presence of an empirical design, focus on the users' experience of e-prescribing implementation, conducted in primary care, and providing data on barriers (...) and facilitators to e-prescribing implementation. We used the Donabedian logical model of healthcare quality (adapted by Barber et al) to analyze our findings.We found 34 publications (related to 28 individual studies) eligible to be included in this review. These studies identified a total of 594 elements as barriers or facilitators to e-prescribing implementation. Most user groups perceived that e-prescribing was facilitated by design and technical concerns, interoperability, content appropriate

2014 Journal of the American Medical Informatics Association

292. 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

293. 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

294. Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers. (Abstract)

women seeking routine care in reproductive health centers who used cigarettes, risky amounts of alcohol, illicit drugs or misused prescription medication.Participants were randomized to enhanced usual care (EUC, n = 151), electronic-delivered SBIRT (e-SBIRT, n = 143) or clinician-delivered SBIRT (SBIRT, n = 145).The primary outcome was days of primary substance abstinence during the 6-month follow-up period. To account for the possibility that patients might substitute a different drug (...) Cost-effectiveness of electronic- and clinician-delivered screening, brief intervention and referral to treatment for women in reproductive health centers. To determine the cost-effectiveness of electronic- and clinician-delivered SBIRT (Screening, Brief Intervention and Referral to Treatment) for reducing primary substance use among women treated in reproductive health centers.Cost-effectiveness analysis based on a randomized controlled trial.New Haven, CT, USA.A convenience sample of 439

2019 Addiction (Abingdon, England) Controlled trial quality: uncertain

295. Identifying musculoskeletal conditions in electronic medical records: a prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database. Full Text available with Trip Pro

Identifying musculoskeletal conditions in electronic medical records: a prevalence and validation study using the Deliver Primary Healthcare Information (DELPHI) database. Musculoskeletal (MSK) conditions are a common presentation in primary care. This study sought to determine the prevalence of MSK conditions in primary care in Ontario and to validate the extent to which health administrative date billing codes accurately represent MSK diagnoses.De-identified electronic medical records (EMR (...) prevalence of MSK was 52.3% and varied by age (4.5% 0-17 years, 20.1% 18-44, 42.7% 45-64, and 32.7% 65+). Patients at MSK encounters had a higher number of: investigations (17.9% compared to 9.1%, p < .0001); referrals (17.6% compared to 14.3%, p < .0001); and prescriptions for opioids (17.2% compared to 5.3%, p < .0001).This study determined the prevalence of musculoskeletal conditions in primary care in Ontario using a reference standard definition. The study highlighted the value of using primary care

2019 BMC Musculoskeletal Disorders

296. Medication Accuracy in Electronic Health Records for Microbial Keratitis. (Abstract)

Medication Accuracy in Electronic Health Records for Microbial Keratitis. Electronic health records (EHRs) contain an abundance of health information. However, researchers need to understand data accuracy to ask appropriate research questions.To investigate the concordance of the names of medications for microbial keratitis in the structured, formal EHR medication list and the text of clinicians' progress notes.This cross-sectional study, conducted in the cornea section of an ophthalmology (...) and 29 women, with a mean (SD) age of 51.8 (19.6) years. Of the 247 medications identified, 57 (23.1%) of prescribed medications differed between the progress notes and the formal EHR-based medication list. Reasons included medications not prescribed via the EHR ordering system (25 [43.9%]), outside medications not reconciled in the internal EHR medication list (23 [40.4%]), and medications prescribed via the EHR ordering system and in the formal list, but not described in the clinical note (9 [15.8

2019 JAMA ophthalmology

297. Use of varenicline and nicotine replacement therapy in people with and without general practitioner-recorded dementia: retrospective cohort study of routine electronic medical records. Full Text available with Trip Pro

dementia who were prescribed varenicline or NRT for smoking cessation.A retrospective cohort study based on the analysis of electronic medical records within the Clinical Practice Research Datalink (2007-2015).683 general practices in England.People with and without GP-recorded dementia, aged 18 years and have a code indicating that they are a current smoker.Index prescription of varenicline or NRT (from 1 September 2006).The primary outcomes were smoking prevalence and prescribing rates of varenicline (...) Use of varenicline and nicotine replacement therapy in people with and without general practitioner-recorded dementia: retrospective cohort study of routine electronic medical records. Our primary objective was to estimate smoking prevalence and prescribing rates of varenicline and nicotine replacement therapy (NRT) in people with and without general practitioner (GP)-recorded dementia. Our secondary objective was to assess and compare quit rates of smokers with versus without GP-recorded

2019 BMJ open

298. Training medical students and residents in the use of electronic health records: a systematic review of the literature. (Abstract)

Training medical students and residents in the use of electronic health records: a systematic review of the literature. Our objectives were to identify educational interventions designed to equip medical students or residents with knowledge or skills related to various uses of electronic health records (EHRs), summarize and synthesize the results of formal evaluations of these initiatives, and compare the aims of these initiatives with the prescribed EHR-specific competencies for undergraduate (...) patient care and population health improvement. In comparing these interventions with the broad set of electronic records competencies expected of matriculating physicians, critical gaps in undergraduate and postgraduate medical education remain.With the increasing adoption of EHRs and rise of competency-based medical education, educators should address the gaps in the training of future physicians to better prepare them to provide high quality care for their patients and communities.© The Author(s

2019 Journal of the American Medical Informatics Association

299. UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER. Full Text available with Trip Pro

UK phenomics platform for developing and validating electronic health record phenotypes: CALIBER. Electronic health records (EHRs) are a rich source of information on human diseases, but the information is variably structured, fragmented, curated using different coding systems, and collected for purposes other than medical research. We describe an approach for developing, validating, and sharing reproducible phenotypes from national structured EHR in the United Kingdom with applications (...) (primary care, subset of SNOMED-CT [Systematized Nomenclature of Medicine Clinical Terms]), (2) International Classification of Diseases-Ninth Revision and Tenth Revision (secondary care diagnoses and cause of mortality), (3) Office of Population Censuses and Surveys Classification of Surgical Operations and Procedures, Fourth Revision (hospital surgical procedures), and (4) DM+D prescription codes.Using the CALIBER phenotyping framework, we created algorithms for 51 diseases, syndromes, biomarkers

2019 Journal of the American Medical Informatics Association

300. Adverse drug reactions caused by drug-drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items. (Abstract)

Adverse drug reactions caused by drug-drug interactions in cardiovascular disease patients: introduction of a simple prediction tool using electronic screening database items. Objective: Cardiovascular disease (CVD) drugs have been frequently implicated in adverse drug reaction (ADR)-related hospitalizations. Drug-drug interactions (DDIs) are common preventable cause of ADRs, but the impact of DDIs in the CVD population has not been investigated. Hence, the primary aim of the study (...) .). Results: DDIs contributed to hospital admission with a total prevalence of 9.69%. DDI-related ADRs affected mainly cardiac function (heart rate or rhythm, 41.07%); bleeding and effect on blood pressure were equally distributed (17.86%). Non-cardiovascular ADRs were found in 23.21% of DDIs. After admission, 73% of the identified DDIs led to changes in prescription. Prediction ability of calculated DDI adverse event probability scores was rated as good (AUC = 0.80, p < .001). Conclusions: CVD patients

2019 Current medical research and opinion

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