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Electronic Prescription

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141. Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record Full Text available with Trip Pro

Quality of Co-Prescribing NSAID and Gastroprotective Medications for Elders in The Netherlands and Its Association with the Electronic Medical Record To assess guideline adherence of co-prescribing NSAID and gastroprotective medications for elders in general practice over time, and investigate its potential association with the electronic medical record (EMR) system brand used.We included patients 65 years and older who received NSAIDs between 2005 and 2010. Prescription data were extracted (...) from EMR systems of GP practices participating in the Dutch NIVEL Primary Care Database. We calculated the proportion of NSAID prescriptions with co-prescription of gastroprotective medication for each GP practice at intervals of three months. Association between proportion of gastroprotection, brand of electronic medical record (EMR), and type of GP practice were explored. Temporal trends in proportion of gastroprotection between electronic medical records systems were analyzed using a random

2015 PloS one

142. A survey of perceptions and attitudes about direct-to-consumer advertising of prescription drugs among college students in South Korea. Full Text available with Trip Pro

by the Korean government, and prescription drugs should not be advertised through the Internet. It is recommended that the Korean government cautiously examine whether DTCA of prescription drugs should be permitted, after considering the current marketing strategies of pharmaceutical companies on the Internet and the effects of online electronic-DTCA on Korean consumers. (...) A survey of perceptions and attitudes about direct-to-consumer advertising of prescription drugs among college students in South Korea. Direct-to-consumer advertising (DTCA) of prescription drugs can be both beneficial and harmful to healthcare consumers. Therefore, DTCA for prescription drugs is a topic that should be considered crucially, at this point, when the interests of patients as well as pharmaceutical companies in DTCA of prescription drugs are growing in South Korea. The goals

2018 PLoS ONE

143. Clinical and cost-effectiveness of non-medical prescribing: A systematic review of randomised controlled trials. Full Text available with Trip Pro

Clinical and cost-effectiveness of non-medical prescribing: A systematic review of randomised controlled trials. To evaluate the clinical and cost-effectiveness of non-medical prescribing (NMP).Systematic review. Two reviewers independently completed searches, eligibility assessment and assessment of risk of bias.Pre-defined search terms/combinations were utilised to search electronic databases. In addition, hand searches of reference lists, key journals and grey literature were employed

2018 PLoS ONE

144. Standardizing Dose Prescriptions: An ASTRO White Paper

Force limited the scope of this effort to a limited number of central prescription items concerning how prescribed dose is specified. All but 2 of these items can be expressed numerically. We specifically differentiate the “key ele- ments” of the prescription from the other components of the radiation therapy prescription (eg, simulation orders, treatment planning objectives, the approved treatment plans, imaging orders, patient instructions for treatment) that are not addressed in detail here (...) vaginal cylinder,” or “Cobalt-60, Gamma Knife.” Standard dose prescriptions white paper e375 Practical Radiation Oncology: November-December 2016than LT CW w/IM). The prescribing radiation oncologist should take care to name the treatment site in a manner that allows others to readily understand which portion of the body is to be treated (eg, “left tonsil and bilateral neck” is preferred over “PTV1”). Laterality should always be included in accordance with current standards, including the recently

2016 American Society for Radiation Oncology

145. Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting Full Text available with Trip Pro

Electronic Prescribing: Improving the Efficiency and Accuracy of Prescribing in the Ambulatory Care Setting Electronic prescribing (e-prescribing) is an important part of the nation's push to enhance the safety and quality of the prescribing process. E-prescribing allows providers in the ambulatory care setting to send prescriptions electronically to the pharmacy and can be a stand-alone system or part of an integrated electronic health record system. The methodology for this study followed (...) the basic principles of a systematic review. A total of 47 sources were referenced. Results of this research study suggest that e-prescribing reduces prescribing errors, increases efficiency, and helps to save on healthcare costs. Medication errors have been reduced to as little as a seventh of their previous level, and cost savings due to improved patient outcomes and decreased patient visits are estimated to be between $140 billion and $240 billion over 10 years for practices that implement e

2014 Perspectives in Health Information Management

146. Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial Full Text available with Trip Pro

with electronic pill bottles nor bidirectional text messaging about medication adherence improved blood pressure control. Adherence to prescribed medications was not improved enough to affect BP control or it was not the primary driver of poor control.clinicaltrials.gov (NCT02778542). (...) Electronic Pill Bottles or Bidirectional Text Messaging to Improve Hypertension Medication Adherence (Way 2 Text): a Randomized Clinical Trial Poor medication adherence contributes to inadequate control of hypertension. However, the value of adherence monitoring is unknown.To evaluate the impact of monitoring adherence with electronic pill bottles or bidirectional text messaging on improving hypertension control.Three-arm pragmatic randomized controlled trial.One hundred forty-nine primary care

2019 EvidenceUpdates

147. Perceptions among Alberta Healthcare Professionals of Prescription Drug Misuse

of Prescription Drug Misuse Executive Summary The Issue Although prescription drugs such as opioids, stimulants, sedatives and tranquillizers are legal and prescribed for therapeutic purposes, there are a number of harms associated with their use. The addiction, withdrawal, injury, overdose and death associated with prescription drugs have been identified as a significant public health and safety concern across North America. For example, nearly one in every eight deaths were opioid-related among individuals (...) to the other drug classes. There were no differences in suspected youth misuse of any of the prescription drug classes. Healthcare professionals reported that the following patient actions were strong indicators of PDM: • Altering the delivery method of a prescription drug; • Forging prescriptions; • Double doctoring; • Doctor shopping; and/or • Using medications differently than were prescribed. The expression by family members or caregivers of worry about prescription drug use was also a strong indicator

2015 Canadian Centre on Substance Abuse

148. Identification of patients with hemoglobin SS/Sβ0 thalassemia disease and pain crises within electronic health records Full Text available with Trip Pro

Identification of patients with hemoglobin SS/Sβ0 thalassemia disease and pain crises within electronic health records Electronic health records (EHRs) are a source of big data that provide opportunities for conducting population-based studies and creating learning health systems, especially for rare conditions such as sickle cell disease (SCD). The objective of our study is to validate algorithms for accurate identification of patients with hemoglobin (Hb) SS/Sβ0 thalassemia and acute care (...) encounters for pain among SCD patients within EHR warehouse. We used data for children receiving care at Children's Hospital of Wisconsin from 2013 to 2016 to test the accuracy of the 2 algorithms. The algorithm for genotype identification used composite information (blood test results, transcranial Doppler) along with diagnoses codes. Acute pain encounters were identified using diagnoses codes and further refined by using prescription of IV pain medications. Sensitivities and specificities were

2018 Blood advances

149. Demand for health services and drug prescriptions among overweight or obese preschool children. (Abstract)

Demand for health services and drug prescriptions among overweight or obese preschool children. To evaluate the association between excess weight and the demand of health services in preschool children compared with healthy weight.The data come from the Longitudinal Study of Childhood Obesity cohort (1884 4-year-old children, residing in the Madrid region, Spain) who provided information through telephone questionnaire, physical examination and electronic medical records. We defined overweight (...) , general and abdominal obesity based on body mass index, waist circumference and waist-to-height ratio. Using mixed models of multivariable negative binomial regression we calculated the incidence rate ratio (IRR) regarding primary care (PC) doctor visits, drug prescriptions and hospital admissions by weight status at the end of the 2-year follow-up.Childhood general obesity was associated with a higher demand for PC services related to psychological problems (IRR=1.53; 95% CI 1.02 to 2.28

2019 Archives of Disease in Childhood

150. Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department. (Abstract)

reduction in the ED [odds ratio (OR), 1.73; 95% CI, 1.20-2.50], received an opioid in the ED (OR, 2.13; 95% CI, 1.43-3.20), or received their prescription from an emergency medicine resident (OR, 2.8; 95% CI, 1.44-5.74).Opioid prescribing differs based on patient- and provider-related factors. Given the variability in prescribing patterns, changing suggested opioid prescriptions in the electronic medical record may lead to more consistent practice and therefore decrease unnecessary prescribing while (...) Factors Associated With Opioid Prescribing for Distal Upper Extremity Fractures at a Pediatric Emergency Department. The aims of this study were to describe the prescribing patterns of oxycodone for patients with distal upper extremity fractures and to evaluate factors that influence the quantity of oxycodone prescribed at discharge.We retrospectively studied oxycodone prescriptions for patients with upper extremity fractures presenting to a single center tertiary pediatric emergency department

2019 Pediatric Emergency Care

151. Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis. Full Text available with Trip Pro

Association between harm reduction strategies and healthcare utilization in patients on long-term prescribed opioid therapy presenting to acute healthcare settings: a protocol for a systematic review and meta-analysis. Opioids are routinely used to treat a variety of chronic conditions associated with pain. However, they are a class of medications with a significant potential for adverse health effects, with and without misuse. Opioid misuse, as defined as inappropriate use of appropriately (...) prescribed opioids, is becoming more well-recognized publicly but does not have clear treatment options. Opioid misuse has been linked to variety of poor outcomes and its consequences have a significant impact on healthcare resource utilization. The evidence on harm reduction strategies to mitigate adverse events prompting presentation to acute care settings for patients presenting with long-term opioid use is sparse.We will perform a systematic review and meta-analysis to catalog effective harm

2019 Systematic reviews

152. Embedding research recruitment in a community resource e-prescribing system: lessons from an implementation study on Chicago's South Side. (Abstract)

Embedding research recruitment in a community resource e-prescribing system: lessons from an implementation study on Chicago's South Side. The study sought to implement and assess the CommunityRx e-prescribing system to recruit research participants from a predominantly non-Hispanic Black community on Chicago's South Side.CommunityRx integrates with electronic medical record systems to generate a personalized list of health-promoting community resources (HealtheRx). Between December 2015 (...) to participate and 9 (8 non-Hispanic Black) returned a signed consent required to enroll. Usual recruitment practices enrolled 4 registrants (1 non-Hispanic Black).Automating research recruitment using a community e-prescribing system is feasible.Implementation of an electronic medical record-integrated, community resource referral tool promotes enrollment of eligible underrepresented research participants; however, enrollment was low.© The Author(s) 2019. Published by Oxford University Press on behalf

2019 Journal of the American Medical Informatics Association

153. Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands. Full Text available with Trip Pro

of 244,328 adults ≥70 years from electronic health records of 415 Dutch general practices from 2011-15 were used. Number of LLD prescriptions in patients with (n = 55,309) and without (n = 189,019) cardiovascular disease (CVD) was evaluated according to age, frailty and comorbidities.about 69% of adults ≥70 years with CVD and 36% without CVD were prescribed a LLD. LLD prescriptions decreased with age; with CVD: 78% aged 70-74 years and 29% aged ≥90 years were prescribed a LLD, without CVD: 37% aged 70-74 (...) Prescription patterns of lipid lowering agents among older patients in general practice: an analysis from a national database in the Netherlands. Dutch cardiovascular risk management guidelines state almost every older adult (≥70 years) is eligible for a lipid lowering drug (LLD). However, life expectancy, frailty or comorbidities may influence this treatment decision.investigate how many older adults, according to age, frailty (Drubbel-frailty index) and comorbidities were prescribed LLDs.data

2019 Age and ageing

154. The utility of a statewide prescription drug-monitoring database vs the Current Opioid Misuse Measure for identifying drug-aberrant behaviors in emergency department patients already on opioids. (Abstract)

The utility of a statewide prescription drug-monitoring database vs the Current Opioid Misuse Measure for identifying drug-aberrant behaviors in emergency department patients already on opioids. The most recent guidelines on prescribing opioids from the United States Centers for Disease Control recommend that clinicians not prescribe opioids as first-line therapy for chronic non-cancer pain. If an opioid prescription is considered for a patient already on opioids, prescribers are encouraged (...) to check the statewide prescription drug monitoring database (PDMP). Some additional guidelines recommend screening tools such as the Current Opioid Misuse Measure (COMM) which may also help identify drug-aberrant behaviors.To compare the PDMP and the Current Opioid Misuse Measure (COMM), a commonly-recommended screening tool for patients on opioids, in detecting drug-aberrant behaviors in patients already taking opioids at the time of ED presentation.Patients on opioids were enrolled prospectively

2019 American Journal of Emergency Medicine

155. Using a Systems Engineering Framework to Evaluate Proton Pump Inhibitor Prescribing in Critically Ill Patients. (Abstract)

intensive care unit, 25% of PPI days were not clinically indicated. Barriers to optimizing PPI prescribing included inadequate provider education, lack of institutional guidelines for stress ulcer prophylaxis, and strong institutional culture favoring PPI use. Potential facilitators included increased pharmacy oversight, provider education, and embedded decision support in the electronic medical record. Interventions addressing barriers noted by front line providers are needed to reduce unnecessary PPI (...) Using a Systems Engineering Framework to Evaluate Proton Pump Inhibitor Prescribing in Critically Ill Patients. Proton pump inhibitors (PPIs) are a risk factor for hospital-acquired Clostridium difficile infection (CDI). Much PPI use is inappropriate, and interventions to reduce PPI use, such as for stress ulcer prophylaxis in all critically ill patients, are essential to reduce CDI rates. This mixed-methods study in a combined medical-surgical intensive care unit at a tertiary academic medical

2019 Journal for Healthcare Quality

156. Residents as Key Effectors of Change in Improving Opioid Prescribing Behavior. (Abstract)

Residents as Key Effectors of Change in Improving Opioid Prescribing Behavior. There is a national imperative to curb the flow of opioids into our communities. In academic medical centers, the majority of discharge opioid prescriptions are written by residents who receive predominantly ad hoc, peer-to-peer education on perioperative analgesia. We aimed to reduce opioid overprescribing after common general surgical operations through a resident led quality improvement project that involved (...) . Residents' attitudes toward opioid prescribing were assessed using an anonymous survey before and after our interventions. Actual opioid prescribing data were abstracted from the electronic health record.A single academic medical center.A surgical resident led a transdisciplinary team consisting of faculty, anesthesiologists, pharmacists, advanced practice providers, and health informaticians within the Department of Surgery.After our educational intervention, residents' impression of the appropriate

2019 Journal of Surgical Education

157. Identifying Factors That Predict the Prescription of Non-vitamin K Antagonist Oral Anticoagulants in Older Individuals With Atrial Fibrillation. (Abstract)

Identifying Factors That Predict the Prescription of Non-vitamin K Antagonist Oral Anticoagulants in Older Individuals With Atrial Fibrillation. Factors that influence decision of non-vitamin K antagonist oral anticoagulants (NOACs) use among older atrial fibrillation (AF) patients in long-term care (LTC) facilities have not been well studied. The aim of this study was to assess whether increased frailty influenced physicians to prescribe NOACs over warfarin.We retrospectively reviewed (...) adjusted for important patient-level factors. Patients with hypertension had a trend of increased NOAC prescriptions but did not reach statistical significance [odds ratio 2.1 (95% CI 0.91, 4.81), P = .08]. None of the patient-level factors were associated with NOAC prescriptions.In this real world cohort of AF patients in LTC who are prescribed an oral anticoagulation therapy, a higher CHESS score (≥2) is associated with increased use of NOACs in comparison to warfarin.Copyright © 2019 AMDA

2019 Journal of the American Medical Directors Association

158. Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study. Full Text available with Trip Pro

Reducing antibiotic prescribing in primary care in England from 2014 to 2017: population-based cohort study. To analyse individual-patient electronic health records to evaluate changes in antibiotic (AB) prescribing in England for different age groups, for male and female subjects, and by prescribing indications from 2014 to 2017.Data were analysed for 102 general practices in England that contributed data to the UK Clinical Practice Research Datalink (CPRD) from 2014 to 2017. Prescriptions (...) for all ABs and for broad-spectrum β-lactam ABs were evaluated. Relative rate reductions (RRR) were estimated from a random-effects Poisson model, adjusting for age, gender, and general practice.Total AB prescribing declined from 608 prescriptions per 1000 person-years in 2014 to 489 per 1000 person-years in 2017; RRR 6.9% (95% CI 6.6% to 7.1%) per year. Broad-spectrum β-lactam AB prescribing decreased from 221 per 1000 person-years in 2014 to 163 per 1000 person-years in 2017; RRR 9.3% (9.0% to 9.6

2019 BMJ open

159. Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts. Full Text available with Trip Pro

Optimising computerised decision support to transform medication safety and reduce prescriber burden: study protocol for a mixed-methods evaluation of drug-drug interaction alerts. Drug-drug interaction (DDI) alerts in hospital electronic medication management (EMM) systems are generated at the point of prescribing to warn doctors about potential interactions in their patients' medication orders. This project aims to determine the impact of DDI alerts on DDI rates and on patient harm (...) in the inpatient setting. It also aims to identify barriers and facilitators to optimal use of alerts, quantify the alert burden posed to prescribers with implementation of DDI alerts and to develop algorithms to improve the specificity of DDI alerting systems.A controlled pre-post design will be used. Study sites include six major referral hospitals in two Australian states, New South Wales and Queensland. Three hospitals will act as control sites and will implement an EMM system without DDI alerts, and three

2019 BMJ open

160. Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting. (Abstract)

usefulness of medication error alerts generated by a novel system using outlier detection screening algorithms, used on top of a legacy standard system, in a real-life inpatient setting.We integrated a novel outlier system into an existing electronic medical record system, in a single medical ward in a tertiary medical center. The system monitored all drug prescriptions written during 16 months. The department's staff assessed all alerts for accuracy, clinical validity, and usefulness. We recorded all (...) Reducing drug prescription errors and adverse drug events by application of a probabilistic, machine-learning based clinical decision support system in an inpatient setting. Drug prescription errors are made, worldwide, on a daily basis, resulting in a high burden of morbidity and mortality. Existing rule-based systems for prevention of such errors are unsuccessful and associated with substantial burden of false alerts.In this prospective study, we evaluated the accuracy, validity, and clinical

2019 Journal of the American Medical Informatics Association

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