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Electronic Prescription

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121. Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System. (PubMed)

intensity, and pain catastrophizing in 1,794 adults (1,129 women; 63%) presenting for new evaluation at a large tertiary care pain treatment center. Data were sourced primarily from an open-source, learning health system and pain registry and secondarily from manual review of electronic medical records. A binary opioid prescription variable (yes/no) constituted the dependent variable; independent variables were age, sex, pain intensity, pain catastrophizing, depression, and anxiety.Most patients were (...) Pain Catastrophizing Moderates Relationships between Pain Intensity and Opioid Prescription: Nonlinear Sex Differences Revealed Using a Learning Health System. Pain catastrophizing is a maladaptive response to pain that amplifies chronic pain intensity and distress. Few studies have examined how pain catastrophizing relates to opioid prescription in outpatients with chronic pain.The authors conducted a retrospective observational study of the relationships between opioid prescription, pain

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2017 Anesthesiology

122. Prescription opioid registry protocol in an integrated health system. (PubMed)

Prescription opioid registry protocol in an integrated health system. To establish a prescription opioid registry protocol in a large health system and to describe algorithms to characterize individuals using prescription opioids, opioid use episodes, and concurrent use of sedative/hypnotics.Protocol development and retrospective cohort study.Using Kaiser Permanente Northern California (KPNC) electronic health record data, we selected patients using prescription opioids in 2011. Opioid (...) and sedative/hypnotic fills, and physical and psychiatric comorbidity diagnoses, were extracted for years 2008 to 2014. Algorithms were developed to identify each patient's daily opioid and sedative/hypnotic use, and morphine daily-dose equivalent. Opioid episodes were classified as long-term, episodic, or acute. Logistic regression was used to predict characteristics associated with becoming a long-term opioid user.In 2011, 18% of KPNC adult members filled at least 1 opioid prescription. Among those

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2017 American Journal Of Managed Care

123. PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. (PubMed)

PIM-Check: development of an international prescription-screening checklist designed by a Delphi method for internal medicine patients. Potentially inappropriate medication (PIM) occurs frequently and is a well-known risk factor for adverse drug events, but its incidence is underestimated in internal medicine. The objective of this study was to develop an electronic prescription-screening checklist to assist residents and young healthcare professionals in PIM detection.Five-step study involving (...) pathologies. An algorithm of approximately 31 000 lines was developed including comorbidities and medications variables to create the electronic tool.PIM-Check is the first electronic prescription-screening checklist designed to detect PIM in internal medicine. It is intended to help young healthcare professionals in their clinical practice to detect PIM, to reduce medication errors and to improve patient safety.© Article author(s) (or their employer(s) unless otherwise stated in the text of the article

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2017 BMJ open

124. Adverse outcomes associated with opioid prescription for acute low back pain: a systematic review protocol. (PubMed)

Adverse outcomes associated with opioid prescription for acute low back pain: a systematic review protocol. Acute low back pain (ALBP) is the top cause of global disability, demonstrating a significant impact on individuals and society and demanding the need for appropriate management. There is a trend towards an increasing number of opioid prescriptions for ALBP despite the lack of investigation for its various short- and long-term outcomes. The objective of this review is to examine adverse (...) outcomes associated with opioid use for ALBP.Using a search strategy, the search will be conducted using the following electronic databases: PubMed/MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, Cochrane Library, the National Institutes for Health Clinical Trials Registry and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). We will include randomized clinical trials and observational studies

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2017 Systematic reviews

125. The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK. (PubMed)

the relationship between area deprivation measured by the Scottish Index of Multiple Deprivation and LARC prescription.Using Scottish electronic prescribing data from primary care and sexual and reproductive health clinics, this study analysed female Lothian residents with a valid postcode aged 16-49 years who received a contraceptive prescription from 1 April 2012 to 31 March 2014. Prescription of LARC (intrauterine, implant or injectable contraceptive) compared with non-LARC (oral pill, patch, ring (...) The relationship between area deprivation and prescription of long-acting reversible contraception in women of reproductive age in Lothian, Scotland, UK. Reducing unplanned pregnancy in Scotland is a key government objective. Long-acting reversible contraception (LARC) is a cost-effective way to reduce unintended pregnancy. Abortion and teenage pregnancy rates are highest in the most deprived areas. One possible explanation could be contraceptive prescribing inequality. This study examined

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2017 Journal of Family Planning and Reproductive Health Care

126. Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis. (PubMed)

Past-year prevalence of prescription opioid misuse among those 11 to 30years of age in the United States: A systematic review and meta-analysis. There are high levels of prescription and consumption of prescription opioids in the US. Misuse of prescription opioids has been shown to be highly correlated with prescription opioid-related morbidity and mortality including fatal and non-fatal overdose. We characterized the past-year prevalence of prescription opioid misuse among those 11-30years (...) of age in the US.A systematic review and meta-analysis were carried out following a published protocol and PRISMA guidelines. We searched electronic databases; reports were eligible if they were published between 1/1/1990-5/30/2014, and included data on individuals 11-30years of age from the US. Study quality was assessed using the Newcastle-Ottawa Scale.A total of 3211 abstracts were reviewed for inclusion; after discarding duplicates and identifying non-eligible reports, a total of 19 unique

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2017 Journal of substance abuse treatment

127. Averting a zombie prescription apocalypse

. These “zombie prescriptions” are a patient safety threat that physicians face daily. Zombie prescriptions have been lurking in our offices for years, but I’ve become more aware of them lately because of the way my practice manages prescription refills. To reduce administrative burdens on physicians, we have protocols for refilling chronic medications, such as antihypertensive and oral hypoglycemic drugs. If the electronic health record (EHR) confirms that the patient is on the drug and he or she is up (...) at another common type of zombie prescription, one where a medication was not discontinued but its dose was adjusted, yet the pharmacy continued to dispense the old dose. While the authors used EHRs to expose the phenomenon, we shouldn’t blame zombie prescriptions on EHRs and electronic prescribing. Even in the paper prescription era, we did not explicitly notify pharmacies that we were discontinuing a medication. However, in the good old days, patients usually filled all of their prescriptions in one

2017 KevinMD blog

128. Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study. (PubMed)

study was conducted to assess potentially inappropriate prescription of antihypertensive drugs, in patients aged 75 years and older with arterial hypertension (HTN), in the month prior to hospital admission, using four instruments: Beers, Screening Tool of Older Person's Prescriptions (STOPP), Screening Tool to Alert Doctors to the Right Treatment (START) and Assessing Care of Vulnerable Elders 3 (ACOVE-3). Primary care and hospital electronic records were reviewed for HTN diagnoses (...) Potentially Inappropriate Antihypertensive Prescriptions to Elderly Patients: Results of a Prospective, Observational Study. Previous studies of antihypertensive treatment of older patients have focused on blood pressure control, cardiovascular risk or adherence, whereas data on inappropriate antihypertensive prescriptions to older patients are scarce.The aim of the study was to assess inappropriate antihypertensive prescriptions to older patients.An observational, prospective multicentric

2017 Drugs & Aging

129. Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) - a study protocol. (PubMed)

Smokers making a quit attempt using e-cigarettes with or without nicotine or prescription nicotine replacement therapy: Impact on cardiovascular function (ISME-NRT) - a study protocol. The estimated number of cigarette smokers in the world is 1.3 billion, expected to rise to 1.7 billion by 2025, with 10 million smokers living in the U.K. Smoking is the leading, preventable death-cause worldwide, being responsible for almost 650,000 deaths in the E.U. annually. A combination of pharmacological (...) interventions, including nicotine replacement therapy, bupropion and varenicline, and behavioural support is the most effective approach to smoking cessation. However, even the best methods have high relapse rates of approximately 75% within 6 months. Electronic (or "e-") cigarettes use battery power to disperse a solution that usually contains propylene glycol or glycerine, water, flavouring and nicotine. E-cigarettes have become the most popular smoking cessation aid in England, however, information

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2017 BMC Public Health

130. A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence. (PubMed)

searches were conducted in March 2015 in eight electronic databases, supplemented by hand-searching reference lists and searches on six National Health Technology Assessment Agency websites. Studies were included if they: investigated populations that were dependent on non-prescription opioids and were receiving opioid agonist or maintenance therapy; compared any pharmacological maintenance intervention with any other maintenance regimen (including placebo or no treatment); and were health-economic (...) A systematic review of health economic models of opioid agonist therapies in maintenance treatment of non-prescription opioid dependence. Opioid dependence is a chronic condition with substantial health, economic and social costs. The study objective was to conduct a systematic review of published health-economic models of opioid agonist therapy for non-prescription opioid dependence, to review the different modelling approaches identified, and to inform future modelling studies.Literature

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2017 Addiction science & clinical practice

131. The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial. (PubMed)

The effect of a test ordering software intervention on the prescription of unnecessary laboratory tests - a randomized controlled trial. The way software for electronic health records and laboratory tests ordering systems are designed may influence physicians' prescription. A randomised controlled trial was performed to measure the impact of a diagnostic and laboratory tests ordering system software modification.Participants were family physicians working and prescribing diagnostic (...) tests from a quick shortcut menu of the diagnosis and laboratory tests ordering system had a significant impact and reduced unnecessary prescription of tests. The fact that it was not possible to perform the randomization at the family physicians' level, but only of the computer servers is a limitation of our study. Future research should assess the impact of different tests ordering systems during longer periods.ISRCTN45427977 , May 1st 2014 (retrospectively registered).

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2017 Medical Informatics and Decision Making

132. Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making (PubMed)

Predictive Modeling of Physician-Patient Dynamics That Influence Sleep Medication Prescriptions and Clinical Decision-Making Insomnia remains under-diagnosed and poorly treated despite its high economic and social costs. Though previous work has examined how patient characteristics affect sleep medication prescriptions, the role of physician characteristics that influence this clinical decision remains unclear. We sought to understand patient and physician factors that influence sleep (...) medication prescribing patterns by analyzing Electronic Medical Records (EMRs) including the narrative clinical notes as well as codified data. Zolpidem and trazodone were the most widely prescribed initial sleep medication in a cohort of 1,105 patients. Some providers showed a historical preference for one medication, which was highly predictive of their future prescribing behavior. Using a predictive model (AUC = 0.77), physician preference largely determined which medication a patient received

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2017 Scientific reports

133. Impact of Guidance on the Prescription Patterns of G-CSFs for the Prevention of Febrile Neutropenia Following Anticancer Chemotherapy: A Population-Based Utilization Study in the Lazio Region (PubMed)

been low.Our objective was to evaluate prescribing patterns for G-CSFs in the prevention of chemotherapy-related FN and to evaluate the impact of regional guidance on G-CSF prescription.We conducted an observational drug-utilization study in the Lazio region of Italy using the Electronic Therapeutic Plan Registry, which collects information on G-CSF prescriptions reimbursed by the regional health service. This registry includes information on demographics, tumour, indication for G-CSF use (...) Impact of Guidance on the Prescription Patterns of G-CSFs for the Prevention of Febrile Neutropenia Following Anticancer Chemotherapy: A Population-Based Utilization Study in the Lazio Region Current guidelines recommend prophylaxis with granulocyte colony-stimulating factors (G-CSFs) for patients with cancer who are at greater risk of febrile neutropenia (FN) while receiving chemotherapy. G-CSF biosimilars are available and represent a savings opportunity; however, their uptake has thus far

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2017 Biodrugs

134. Emergency department discharge prescription errors in an academic medical center (PubMed)

Emergency department discharge prescription errors in an academic medical center This study described discharge prescription medication errors written for emergency department patients. This study used content analysis in a cross-sectional design to systematically categorize prescription errors found in a report of 1000 discharge prescriptions submitted in the electronic medical record in February 2015. Two pharmacy team members reviewed the discharge prescription list for errors. Open-ended (...) data were coded by an additional rater for agreement on coding categories. Coding was based upon majority rule. Descriptive statistics were used to address the study objective. Categories evaluated were patient age, provider type, drug class, and type and time of error. The discharge prescription error rate out of 1000 prescriptions was 13.4%, with "incomplete or inadequate prescription" being the most commonly detected error (58.2%). The adult and pediatric error rates were 11.7% and 22.7

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2017 Proceedings (Baylor University. Medical Center)

135. The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida (PubMed)

The current utilization and perceptions of prescription drug monitoring programs among emergency medicine providers in Florida Pain is among the most commonly treated symptoms in the emergency department, and opioids are commonly prescribed from the emergency department to treat moderate to severe pain. Prescription drug monitoring programs (PDMP) can be used to assist physicians identify individuals at increased risk to misuse or abuse opioids. While the use of the PDMP has been shown useful (...) among clinicians, in the past, utilization of the PDMP has been less than optimal. The objective of this study was to assess the current utilization and perceptions of the prescription drug monitoring program among emergency medicine providers in Florida.A survey assessing the utilization and perception of Florida's prescription drug monitoring program was distributed to emergency medicine providers in Florida over a 5 week period. Attending physicians, physicians in training, and extenders from

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2017 International journal of emergency medicine

136. Prevalence and Incidence Trends for Diagnosed Prescription Opioid Use Disorders in the United Kingdom (PubMed)

opioid use disorders in the UK.In a retrospective electronic health care database analysis using data from the UK Clinical Practice Research Datalink (CPRD), we identified persons receiving a first opioid prescription between January 1, 2008 and December 31, 2012. Persons with an opioid use disorder were identified by Read codes assigned by patients' physicians within 6 months following an opioid prescription. We calculated prevalence and incidence rates by dividing the analysis population (...) Prevalence and Incidence Trends for Diagnosed Prescription Opioid Use Disorders in the United Kingdom The prevalence of prescription opioid use disorders in the US has increased markedly in parallel with increases in opioid prescribing. Whilst an increase in opioid prescribing has also occurred in the UK, it remains unknown if there have been concurrent increases in opioid use disorders. The aim of this study was to examine national trends in the prevalence and incidence of physician-diagnosed

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2017 Pain and therapy

137. Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions (PubMed)

infections (URI). Twenty health facilities were randomly selected, including four county hospitals, eight township hospitals and eight village clinics. Prescriptions were extracted from the electronic records in the county hospitals and paper copies in the township hospitals and village clinics.The antibiotic prescription rate was higher in township hospitals (593/877, 68%) compared to county hospitals (2736/8166, 34%) and village clinics (96/297, 32%) (p < 0.001). Among prescriptions containing (...) Antibiotic prescribing for upper respiratory infections among children in rural China: a cross-sectional study of outpatient prescriptions Overuse of antibiotics contributes to the development of antimicrobial resistance.This study aims to assess the condition of antibiotic use at health facilities at county, township and village levels in rural Guangxi, China.We conducted a cross-sectional study of outpatient antibiotic prescriptions in 2014 for children aged 2-14 years with upper respiratory

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2017 Global health action

138. Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study (PubMed)

aimed to characterise the pattern of antibiotic prescriptions for patients diagnosed with acute respiratory tract infections, by means of electronic prescriptions, labeled with clinical indications, from Danish general practice. Acute respiratory tract infections accounted for 456,532 antibiotic prescriptions issued between July 2012 and June 2013. Pneumonia was the most common indication with 178,354 prescriptions (39%), followed by acute tonsillitis (21%) and acute otitis media (19%). In total (...) Characterisation of antibiotic prescriptions for acute respiratory tract infections in Danish general practice: a retrospective registry based cohort study Inappropriate use of antibiotics is contributing to the increasing rates of antimicrobial resistance. Several Danish guidelines on antibiotic prescribing for acute respiratory tract infections in general practice have been issued to promote rational prescribing of antibiotics, however it is unclear if these recommendations are followed. We

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2017 NPJ primary care respiratory medicine

139. Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom (PubMed)

Patterns of antimicrobial agent prescription in a sentinel population of canine and feline veterinary practices in the United Kingdom Antimicrobial resistance is an increasingly important global health threat and the use of antimicrobial agents is a key risk factor in its development. This study describes antimicrobial agent prescription (AAP) patterns over a 2year period using electronic health records (EHRs) from booked consultations in a network of 457 sentinel veterinary premises (...) in the United Kingdom. A semi-automated classification methodology was used to map practitioner defined product codes in 918,333 EHRs from 413,870 dogs and 352,730 EHRs from 200,541 cats, including 289,789 AAPs. AAP as a proportion of total booked consultations was more frequent in dogs (18.8%, 95% confidence interval, CI, 18.2-19.4) than cats (17.5%, 95% CI 16.9-18.1). Prescription of topical antimicrobial agents was more frequent in dogs (7.4%, 95% CI 7.2-7.7) than cats (3.2%, 95% CI 3.1-3.3), whilst

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2017 Veterinary journal (London, England : 1997)

140. Effect Of A “No Superuser Opioid Prescription” Policy On ED Visits And Statewide Opioid Prescription (PubMed)

that they would no longer receive opioid prescriptions from visits to the ED for chronic pain complaints. Electronic medical record (EMR) alerts notified ED providers of the patient's referral at subsequent visits. We analyzed one year of data pre- and post-referral.A total of 243 patients had one year of data post-referral for analysis. Median annual ED visits decreased from 14 to 4 (58% decrease, 95% CI [50 to 66]). We also found statistically significant decreases for these patients' state prescription (...) Effect Of A “No Superuser Opioid Prescription” Policy On ED Visits And Statewide Opioid Prescription The U.S. opioid epidemic has highlighted the need to identify patients at risk of opioid abuse and overdose. We initiated a novel emergency department- (ED) based interventional protocol to transition our superuser patients from the ED to an outpatient chronic pain program. The objective was to evaluate the protocol's effect on superusers' annual ED visits. Secondary outcomes included

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2017 Western Journal of Emergency Medicine

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