Identification of undocumented over-the-counter medications in an academic nephrology clinic.
Identification of undocumented over-the-counter medications in an academic nephrology clinic.
复制标题
在学术肾脏病诊所中识别无证件的非处方药。
DOI：
10.1016/j.japh.2020.08.002
复制
发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Vordenberg SE
中科院分区：
文献类型：
--
作者：
Kokaly AN;Kurlander JE;Pais K;Lee C;Schaefer JK;Heung M;Vordenberg SE
探讨在学术肾脏病诊所中记录非处方（OTC）药物的准确性以及使用新型简短问卷作为药物核对（MR）一部分的获益。我们制定了一份3项定制问卷，其中包括关于阿司匹林、非甾体抗炎药（NSAID）和质子泵抑制剂（PPI）使用的问题，临床领导将其确定为感兴趣的药物。在20天的过程中，医疗助理管理的问卷调查后，立即对门诊患者的标准MR。我们总结了不准确的药物记录的个别药物和药物类别的比率，比较标准的MR过程与问卷调查。我们还计算了问卷的诊断性能特征。我们评估了使用OTC药物调查问卷发现的OTC药物与患者的其他处方药之间的药物相互作用的严重程度。近30%（n = 133/450）的参与者在标准MR后至少有1种记录不准确的OTC药物。标准MR的敏感性和特异性分别为79.2%和93.5%，阿司匹林; 14.5%和99.5%的NSAID; 80.4%和97.3%的PPI。在使用问卷的大约三分之二的时间内，在电子健康记录中解决了药物遗漏。在9.6%的患者中确定了至少1种涉及主动使用OTC药物的药物相互作用（DDI）。在DDI中，最常见的先兆效应是肾毒性增加（52.9%）、出血风险增加（22.9%）和抗血小板活性增强（7.1%）。尽管有标准的MR过程，但在肾脏病诊所的近三分之一的门诊患者中，常用OTC药物的记录不准确。一份简短的OTC药物调查问卷可能是解决这一问题的可扩展和有效的策略。
To explore how accurately over-the-counter (OTC) medications were documented in an academic nephrology clinic and the benefits of using a novel short questionnaire as part of medication reconciliation (MR). We developed a 3-item tailored questionnaire with questions about use of aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and proton pump inhibitors (PPIs), which clinical leadership identified as medications of interest. Over the course of 20 days, medical assistants administered the questionnaire to clinic patients immediately after the standard MR. We summarized the rate of inaccurate medication documentation by individual drug and drug class, comparing the standard MR process with the questionnaire. We also calculated diagnostic performance characteristics of the questionnaire. We evaluated the severity of drug-drug interactions between OTC medications discovered using the OTC medication questionnaire and patients’ other prescription medications. Nearly 30% (n = 133 of 450) of the participants had at least 1 inaccurately documented OTC medication after the standard MR. The sensitivity and specificity of the standard MR were 79.2% and 93.5%, respectively, for aspirin; 14.5% and 99.5% for NSAIDs; and 80.4% and 97.3% for PPIs. Medication omissions were resolved in the electronic health record approximately two-thirds of the time using the questionnaire. At least 1 drug-drug interaction (DDI) involving active use of an OTC medication was identified in 9.6% of the patients. Of the DDIs, the most common portended effects were increased nephrotoxicity (52.9%), increased bleeding risk (22.9%), and enhanced antiplatelet activity (7.1%). Despite the standard MR process, inaccurate documentation of commonly used OTC medications occurred in nearly one-third of outpatients in a nephrology clinic. A brief OTC medication questionnaire may be a scalable and effective strategy to address this problem.
登录
查看更多内容
对老年人的非甾体类抗炎药物的全面综述。
影响因子：
7.4
作者：
Wongrakpanich S;Wongrakpanich A;Melhado K;Rangaswami J
通讯作者：
Rangaswami J
影响因子：
13.2
作者：
Laliberte, Marie-Claude;Normandeau, Michelle;Lalonde, Lyne
通讯作者：
Lalonde, Lyne
质子泵抑制剂在美国门诊环境中的使用，2002-2009 年。
影响因子：
3.7
作者：
Rotman SR;Bishop TF
通讯作者：
Bishop TF
影响因子：
2.8
作者：
Stuntz, Mark;Bernstein, Brent
通讯作者：
Bernstein, Brent
影响因子：
3.2
作者：
Soller, RW
通讯作者：
Soller, RW