The use of a CPOE log for the analysis of physicians' behavior when responding to drug-duplication reminders
The use of a CPOE log for the analysis of physicians' behavior when responding to drug-duplication reminders
复制标题
使用 CPOE 日志分析医生响应药物重复提醒时的行为
DOI：
10.1016/j.ijmedinf.2007.10.002
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发表时间：
2008
影响因子：
4.9
通讯作者：
W. Chiu
中科院分区：
文献类型：
--
作者：
An;P. Chang;Y. Li;W. Chiu
有证据表明，尽管使用了计算机安全提醒系统，但患者仍被开具了大量重复处方。尽管如此，医生对电脑提醒的行为还没有得到很好的研究。这个问题很重要，因为药物重复会导致患者过量服用，产生不可预测的或不良的影响；此外，这也浪费了大量的医疗资源。方法2005年在台湾北部某737床位教学医院实施医嘱计算机录入（CPOE）药品重复提醒系统。在2005年下半年，使用Mantel-Haenszel技术对日志文件和医生档案进行了统计检查。结果共有11,298份订单涉及药品重复提醒，占研究期间188,182份订单的896,131份订单的1.26%。医生相关变量（工作量、科室、学历、在目标医院工作年限和年龄）、政策相关变量（保险公司和医院管理部门的干预）、医嘱本身（药品价格和药物类别）和患者的抗拒程度对医生提醒行为的影响最为显著。台湾的国民保险报销政策的干预作为一种影响医生行为的方式似乎是无效的。结论如果CPOE设计得当，日志文件可作为分析医生提醒行为的宝贵资源。医院、临床医生和患者应该更加重视并认真关注CPOE提醒。重新检查医生的工作量和保险公司关于药物重复的报销政策也很重要。
INTRODUCTIONThere is evidence that patients are being prescribed a significant number of duplicated prescriptions despite the use of computerized safety reminder systems. Nonetheless, the physicians’ behavior with respect to the computer reminders has not been well studied as yet. This problem is important because drug duplication can result in patient overdose with unpredictable or undesirable effects; furthermore, it is also a waste of significant healthcare resources.METHODSIn 2005, a computerized drug-duplication reminder system on the computerized physician order entry (CPOE) was implemented at a 737-bed teaching hospital in northern Taiwan. The log file, combined with the physicians’ profiles, was statistically examined using the Mantel–Haenszel technique over the second half of 2005.RESULTSA total of 11,298 orders (1.26%) involved drug-duplication reminders and this was out of 896,131 orders in 188,182 order set during the study period. The physicians related variables (workload, department, educational background, years in practice at the target hospital and age), policy related variables (intervention from the insurer and hospital administration), the order itself (drug price and medication class) and patients’ resistance were found to be most critically related to physicians’ behaviors in terms of the reminders. Intervention by Taiwan's National Insurance reimbursement policy appeared to be ineffective as a way of affecting the physicians’ behavior.CONCLUSIONThe log file appears to be a valuable source for analyzing physicians’ behavior on reminders if well designed with the CPOE. Hospitals, clinicians and patients should pay more attention and be seriously concerned about CPOE reminders. It is also important to reexamine the physicians’ workload and the insurer reimbursement policy in relation to drug duplication.
使用民族志构建工作系统：重新思考基本设计假设。
DOI：
--
发表时间：
1992
期刊：
Proceedings. Symposium on Computer Applications in Medical Care
影响因子：
--
作者：
Forsythe,DE
通讯作者：
Forsythe,DE