The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care.
The medical office of the 21st century (MOXXI): effectiveness of computerized decision-making support in reducing inappropriate prescribing in primary care.
复制标题
21 世纪医疗办公室 (MOXXI)：计算机化决策支持在减少初级保健中不当处方方面的有效性。
DOI：
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
R. Laprise
中科院分区：
文献类型：
--
作者：
R. Tamblyn;A. Huang;R. Perreault;A. Jacques;Denis Roy;J. Hanley;P. Mcleod;R. Laprise
背景
药物相关不良事件在老年人中很常见，不适当的处方是一个可以预防的风险因素。我们的目标是确定是否可以减少不适当的处方时，初级保健医生有基于计算机的访问信息的所有处方分配和自动警报的潜在处方问题。
方法
我们将107名初级保健医生和至少100名年龄在66岁及以上的患者（共12560名）随机分配到接受计算机决策支持（CDS）的一组或对照组。CDS组的医生可以通过一个专用的计算机链接到省老年人药物保险计划，获得有关当前和过去处方的信息。当CDS软件识别出159个临床相关处方问题中的任何一个时，医生会收到一个警报，该警报识别了问题的性质、可能的后果和替代治疗。在13个月的时间内评估了潜在不适当处方的开始和停止率。
结果
在研究前2个月，CDS组31.8%的患者和对照组33.3%的患者至少有1次潜在不适当的处方。研究期间，CDS组每1000次就诊中新的可能不适当的处方数量显着低于对照组（18%）（相对率[RR] 0.82，95%置信区间[CI] 0.69-0.98），但是，两组之间在潜在不适当处方的停用率方面的差异仅在治疗重复方面有显著性，研究医生和另一名医生（RR 1.66，95% CI 0.99-2.79）以及研究医生开具的处方引起的药物相互作用（RR 2.15，95% CI 0.98-4.70）。
解释
基于计算机的访问完整的药物配置文件和潜在的处方问题的警报降低了潜在的不适当的处方的启动率，但有一个更有选择性的影响，这种处方的中止。
BACKGROUND
Adverse drug-related events are common in the elderly, and inappropriate prescribing is a preventable risk factor. Our objective was to determine whether inappropriate prescribing could be reduced when primary care physicians had computer-based access to information on all prescriptions dispensed and automated alerts for potential prescribing problems.
METHODS
We randomly assigned 107 primary care physicians with at least 100 patients aged 66 years and older (total 12 560) to a group receiving computerized decision-making support (CDS) or a control group. Physicians in the CDS group had access to information on current and past prescriptions through a dedicated computer link to the provincial seniors' drug-insurance program. When any of 159 clinically relevant prescribing problems were identified by the CDS software, the physician received an alert that identified the nature of the problem, possible consequences and alternative therapy. The rate of initiation and discontinuation of potentially inappropriate prescriptions was assessed over a 13-month period.
RESULTS
In the 2 months before the study, 31.8% of the patients in the CDS group and 33.3% of those in the control group had at least 1 potentially inappropriate prescription. During the study the number of new potentially inappropriate prescriptions per 1000 visits was significantly lower (18%) in the CDS group than in the control group (relative rate [RR] 0.82, 95% confidence interval [CI] 0.69-0.98), but differences between the groups in the rate of discontinuation of potentially inappropriate prescriptions were significant only for therapeutic duplication by the study physician and another physician (RR 1.66, 95% CI 0.99-2.79) and drug interactions caused by prescriptions written by the study physician (RR 2.15, 95% CI 0.98-4.70).
INTERPRETATION
Computer-based access to complete drug profiles and alerts about potential prescribing problems reduces the rate of initiation of potentially inappropriate prescriptions but has a more selective effect on the discontinuation of such prescriptions.
DOI：
10.1001/jama.274.1.35
发表时间：
1995-07
期刊：
JAMA
影响因子：
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作者：
L. Leape;D. Bates;D. Cullen;J. Cooper;H. Demonaco;T. Gallivan;R. Hallisey;J. Ives;N. Laird;G. Laffel
通讯作者：
L. Leape;D. Bates;D. Cullen;J. Cooper;H. Demonaco;T. Gallivan;R. Hallisey;J. Ives;N. Laird;G. Laffel
基于计算机的药物利用审查——风险、益处还是无用功？
DOI：
10.1056/nejm199506153322411
发表时间：
1995
期刊：
The New England journal of medicine.
影响因子：
--
作者：
Soumerai,SB;Lipton,HL
通讯作者：
Lipton,HL
影响因子：
120.7
作者：
BATES, DW;CULLEN, DJ;LEAPE, LL
通讯作者：
LEAPE, LL