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Electronic Prescription

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4581. Chronic Opioid Therapy and Central Sensitization in Sickle Cell Disease. Full Text available with Trip Pro

Chronic Opioid Therapy and Central Sensitization in Sickle Cell Disease. Chronic opioid therapy (COT) for chronic non-cancer pain is frequently debated, and its effectiveness is unproven in sickle cell disease (SCD). The authors conducted a descriptive study among 83 adult SCD patients and compared the severity of disease and pain symptoms among those who were prescribed COT (n=29) with those who were not using COT. All patients completed baseline laboratory pain assessment and questionnaires (...) between January 2010 and June 2014. Thereafter, participants recorded daily pain, crises, function, and healthcare utilization for 90 days using electronic diaries. Analyses were conducted shortly after the final diary data collection period. Patients on COT did not differ on age, sex, or measures of disease severity. However, patients on COT exhibited greater levels of clinical pain (particularly non-crisis); central sensitization; and depression and increased diary measures of pain severity

2016 American journal of preventive medicine

4582. What evidence is there for a delay in diagnostic coding of RA in UK general practice records? An observational study of free text. Full Text available with Trip Pro

What evidence is there for a delay in diagnostic coding of RA in UK general practice records? An observational study of free text. Much research with electronic health records (EHRs) uses coded or structured data only; important information captured in the free text remains unused. One dimension of EHR data quality assessment is 'currency' or timeliness, that is, data are representative of the patient state at the time of measurement. We explored the use of free text in UK general practice (...) and earlier referrals to rheumatology, tests, swelling, pain and DMARD prescriptions, suggestive of an earlier implicit diagnosis than was recorded by the diagnostic code.RA-related symptoms, tests, referrals and prescriptions were recorded in free text with 22% of patients showing strong evidence of delay in coding of diagnosis. Researchers using EHRs may need to mitigate for delayed codes by incorporating text into their case-ascertainment strategies. Natural language processing techniques have

2016 BMJ open

4583. Chinese Herb Use by Patients at a San Francisco Chinatown Public Health Center. (Abstract)

%), cold/flu (25%), and headache (6%). Sixty-four percent of respondents had used Western medicine in combination with CHM within the last 12 months. Sixty-nine percent of respondents who used CHM did not tell their Western provider about this use. No patient had CHM use documented in the electronic medical record.Patients seen at a Chinatown public health center frequently used CHM products in conjunction with Western prescription medicines. Providers should routinely enquire about CHM use for health (...) center.Adult patients visiting their primary care provider.Completion of a voluntary 24-question survey on CHM use.Prevalence, type, and indications for use.Survey response rate was 29% (50/170). Seventy percent (35/50) of respondents had used CHM in the last 12 months and 94% (33/35) were also taking prescription medicines. The three most commonly used CHM were goji berry (37%), Dioscorea (31%), and ginseng (23%). The most common indications for herbs used in the last 12 months were general wellness (34

2016 Journal of Alternative and Complementary Medicine

4584. GPs' and community pharmacists' opinions on medication management at transitions of care in Ireland. Full Text available with Trip Pro

GPs' and community pharmacists' opinions on medication management at transitions of care in Ireland. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable (...) . The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems

2016 Family Practice

4585. Impact of hypoglycemic events and HbA1c level on sulfonylurea discontinuation and down-titration. (Abstract)

Impact of hypoglycemic events and HbA1c level on sulfonylurea discontinuation and down-titration. A retrospective cohort study using GE Centricity electronic medical records assessed the association between post-index hypoglycemia and HbA1c with discontinuation and down-titration of sulfonylureas among patients with Type 2 diabetes mellitus.Adult patients with an index prescription for a sulfonylurea and ≥12 months' continuous records pre- and post-index were eligible. Sulfonylurea (...) discontinuation and down-titration was assessed 1-year post-index. Discontinuation occurred if the date of a prescription was >90 days from the preceding prescription plus days of supply. Down-titration occurred when a subsequent prescription was lower than the index dose. Cox regression assessed the association between post-index hypoglycemia and HbA1c with time to sulfonylurea discontinuation and down-titration, as well as other factors.28,371 participants were included in the study; 13,459 (47.4%) were

2016 Expert review of pharmacoeconomics & outcomes research

4586. Supporting Treatment Adherence Readiness through Training (START) for patients with HIV on antiretroviral therapy: study protocol for a randomized controlled trial. Full Text available with Trip Pro

is to examine the effects of START on antiretroviral adherence and HIV virologic suppression.A sample of 240 patients will be randomized to receive START or usual care at one of two HIV clinics. Primary outcomes will be optimal dose-taking adherence (>85 % prescribed doses taken), as measured with electronic monitoring caps, and undetectable HIV viral load. Secondary outcomes will include dose-timing adherence (>85 % prescribed doses taken on time) and CD4 count. Primary endpoints will be month 6 (short (...) -term effect) and month 24 (to test durability of effect), though electronic monitoring will be continuous and a fully battery of assessments will be administered every 6 months for 24 months.If efficacious and cost-effective, START will provide clinicians with a model for assessing patient adherence readiness and helping patients to achieve and sustain readiness and optimal treatment benefits.ClinicalTrials.gov identifier NCT02329782 . Registered on 22 December 2014.

2016 Trials Controlled trial quality: uncertain

4587. Medication Adherence Among Adolescents with Bipolar Disorder. Full Text available with Trip Pro

gathered through an electronic weekly pillbox. Demographic and clinical factors were assessed through self, parent, and physician ratings at baseline, 3, and 6 months.Objective data indicate 41.5% of doses (58.6% of days) were not taken as prescribed over a mean of 3 months of follow-up. Subjective reports (patient, parent, and physician) significantly overestimated adherence as compared with objective data. Factors from multiple domains were associated with poorer adherence, including more daily doses (...) Medication Adherence Among Adolescents with Bipolar Disorder. To examine medication adherence and associated factors among adolescents with bipolar disorder (BP) using both objective and subjective methods.Participants were 21 adolescents with a primary BP diagnosis recruited from a pediatric specialty clinic. All participants were prescribed at least one psychotropic medication. Self- and parent-reported adherence were assessed monthly over 6 months. Objective data on medication adherence were

2016 Journal of Child and Adolescent Psychopharmacology

4588. Adding ribavirin to newer DAA regimens does not affect SVR rates in HCV genotype 1 infected persons: results from ERCHIVES. (Abstract)

Electronically Retrieved Cohort of HCV Infected Veterans (ERCHIVES), a well-established national cohort of HCV-infected Veterans to identify HCV genotype 1 infected persons initiated on the above regimens. We excluded those with HIV coinfection, positive HBsAg and missing HCV RNA.We identified 1235 persons on PrOD (75.5% ribavirin), 1254 on sofosbuvir/simeprevir (16.9% ribavirin) and 4247 on sofosbuvir/ledipasvir (23.3% ribavirin). Among HCV genotype 1a infected persons, ribavirin was prescribed to 99.2

2016 Alimentary Pharmacology & Therapeutics

4589. Objective Assessment of Adherence to Inhalers by COPD Patients. (Abstract)

Objective Assessment of Adherence to Inhalers by COPD Patients. Objective adherence to inhaled therapy by patients with chronic obstructive pulmonary disease (COPD) has not been reported.To objectively quantify adherence to preventer Diskus inhaler therapy by patients with COPD with an electronic audio recording device (INCA).This was a prospective observational study. On discharge from hospital patients were given a salmeterol/fluticasone inhaler with an INCA device attached. Analysis (...) errors in technique.These data may inform clinicians in understanding why a prescribed inhaler is not effective and to devise strategies to promote adherence in COPD.

2016 American Journal of Respiratory and Critical Care Medicine

4590. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. Full Text available with Trip Pro

Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation. Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia.Retrospective medication utilization evaluation.Thirty Veterans Affairs medical (...) centers.Inpatients discharged with a diagnosis of pneumonia.A manual review of electronic medical records of inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was conducted. Appropriate CAP therapy duration was defined as at least 5 days, and up to 3 additional days beginning the first day the patient achieved clinical stability criteria; the appropriate HCAP therapy duration was defined as 8 days. The duration of antimicrobial therapy

2016 Journal of Hospital Medicine

4591. Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model. Full Text available with Trip Pro

ulcers and to identify coding issues leading to penalties.We evaluated all hospitalized patient electronic medical records at an academic medical center data repository between 2011 and 2014. These data contained patient encounter level demographic variables, diagnoses, prescription drugs, and provider orders. HAPUs were defined by PSI-03: stages III, IV, or unstageable pressure ulcers not present on admission as a secondary diagnosis, excluding cases of paralysis. Random forests reduced data (...) Using clinical data to predict high-cost performance coding issues associated with pressure ulcers: a multilevel cohort model. Hospital-acquired pressure ulcers (HAPUs) have a mortality rate of 11.6%, are costly to treat, and result in Medicare reimbursement penalties. Medicare codes HAPUs according to Agency for Healthcare Research and Quality Patient-Safety Indicator 3 (PSI-03), but they are sometimes inappropriately coded. The objective is to use electronic health records to predict pressure

2016 Journal of the American Medical Informatics Association

4592. Evaluation of a combined lifestyle intervention for overweight and obese patients in primary health care: a quasi-experimental design. Full Text available with Trip Pro

and metabolic measurements, morbidity, drugs prescriptions and general practitioner (GP) consultations were extracted from electronic health records (timeframe: July 2009-August 2013). Using a quasi-experimental design, health outcomes of 127 patients who participated in a 1-year CLI were compared to a group of 254 matched patients that received usual care. Baseline to post-intervention changes in health outcomes between intervention and comparison group were evaluated using mixed model analyses.Compared (...) in drugs prescriptions and number of GP consultations.A CLI for overweight and obese patients in primary health care resulted in similar effects on health outcomes compared to usual care. Only an improvement on HDL cholesterol was shown. This study indicates that implementation and evaluation of a lifestyle intervention in primary health care is challenging due to political and financial barriers.© The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e

2016 Family Practice Controlled trial quality: uncertain

4593. Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study. Full Text available with Trip Pro

Glycaemic control and antidiabetic treatment trends in primary care centres in patients with type 2 diabetes mellitus during 2007-2013 in Catalonia: a population-based study. To assess trends in prescribing practices of antidiabetic agents and glycaemic control in patients with type 2 diabetes mellitus (T2DM).Cross-sectional analysis using yearly clinical data and antidiabetic treatments prescribed obtained from an electronic population database.Primary healthcare centres, including the entire

2016 BMJ open

4594. Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach. Full Text available with Trip Pro

and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA's existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non (...) -VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet.This study provides documentation of the current VA HIT system and efforts for consumers' vision of an integrated system redesign. The HIT Systems Matrix provides

2016 Journal of medical Internet research

4595. Developing physical activity counselling in primary care through participatory action approach. Full Text available with Trip Pro

Prescription (PAP), iv) internal and external collaboration and v) use of electronic patient record system in PA counselling.Four Finnish health centres participated. Each nominated a working group for reaching the goals through a 6-month development work, which was supported with monthly tutorials by the research group. The outcome evaluation of the development work included 19 variables, which reflected the five goals and were assessed before (baseline) and after the development work (follow-up

2016 BMC Family Practice

4596. Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System. Full Text available with Trip Pro

Time-to-Cessation of Postoperative Opioids: A Population-Level Analysis of the Veterans Affairs Health Care System. This study aims to determine 1) the epidemiology of perioperative opioid use; and 2) the association between patterns of preoperative opioid use and time-to-cessation of postoperative opioids.Retrospective, cohort study.National, population-level study of Veterans Healthcare Administration (VHA) electronic clinical data.All VHA patients (n = 64,391) who underwent surgery in 2011 (...) , discharged after stays of ≥1 day, and receiving ≥1 opioid prescription within 90 days of discharge.Patients' preoperative opioid use were categorized as 1) no opioids, 2) tramadol only, 3) short-acting (SA) acute/intermittent (≤ 90 days fill), 4) SA chronic (> 90 days fill), or 5) any long-acting (LA). After defining cessation as 90 consecutive, opioid-free days, the authors calculated time-to-opioid-cessation (in days), from day 1 to day 365, after hospital discharge. The authors developed extended Cox

2016 Pain Medicine

4597. A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship. Full Text available with Trip Pro

A cross-sectional study of blood cultures and antibiotic use in patients admitted from the Emergency Department: missed opportunities for antimicrobial stewardship. Early review of antimicrobial prescribing decisions within 48 h is recommended to reduce the overall use of unnecessary antibiotics, and in particular the use of broad-spectrum antibiotics. When parenteral antibiotics are used, blood culture results provide valuable information to help decide whether to continue, alter or stop (...) antibiotics at 48 h. The objective of this study was to investigate the frequency of parenteral antibiotic use, broad spectrum antibiotic use and use of blood cultures when parenteral antibiotics are initiated in patients admitted via the Emergency Department.We used electronic health records from patients admitted from the Emergency Department at University Hospital Birmingham in 2014.Six percent (4562/72939) of patients attending the Emergency department and one-fifth (4357/19034) of those patients

2016 BMC Infectious Diseases

4598. Adherence to antidepressants is associated with lower mortality: a 4-year population-based cohort study. (Abstract)

the electronic medical record database of the largest health provider in Israel (53% of the nation's population) on a total of 251,745 patients aged 40 years and above who filled an antidepressant prescription at least once between 2008 and 2011. The main outcome measure was all-cause mortality during the study period. Adherence was measured as a continuous variable representing possession ratio (duration of filled antidepressant divided by duration of prescribed antidepressant). A polynomial model

2016 Journal of Clinical Psychiatry

4599. Patterns of care among first-time referrals to rheumatologists: Characteristics and timeliness of consultations and treatment in Ontario, Canada. (Abstract)

Patterns of care among first-time referrals to rheumatologists: Characteristics and timeliness of consultations and treatment in Ontario, Canada. Our aim was to characterize referrals to rheumatologists, the early care management of patients with rheumatic diseases, and timeliness of care and treatment.We conducted a retrospective observational study involving patients with first-time rheumatology referrals between 2000 and 2013 in the primary care Electronic Medical Record Administrative data (...) diagnosis associated with the referral included osteoarthritis (32%), systemic inflammatory rheumatic diseases (31%), regional musculoskeletal conditions (16%), chronic pain conditions (14%), osteoporosis (2%), and other/miscellaneous (5%). Family physicians most frequently prescribed nonsteroidal antiinflammatory drugs/cyclooxygenase 2 inhibitors (38%), and their pre-referral diagnostic testing practice varied considerably. The duration of time from symptom onset to rheumatology consultation varied

2016 Arthritis care & research

4600. Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper. Full Text available with Trip Pro

allergy workup. In the future, electronic prescription systems with alert functions will become more common and should include the same information as in paper-based documentation.© 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. (...) Drug allergy passport and other documentation for patients with drug hypersensitivity - An ENDA/EAACI Drug Allergy Interest Group Position Paper. The strongest and best-documented risk factor for drug hypersensitivity (DH) is the history of a previous reaction. Accidental exposures to drugs may lead to severe or even fatal reactions in sensitized patients. Preventable prescription errors are common. They are often due to inadequate medical history or poor risk assessment of recurrence of drug

2016 Allergy

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