Pharmaceutical Safety Tracking (PhaST): Managing Medications for Patient Safety

PhaST是一个帮助临床医生的健康信息系统？药物管理 在流动环境中。PhaST旨在保护门诊病人服用的药物， 即使这些药物是正确处方的，也存在公认的副作用风险。现有 用于监测危险药物的临床策略依赖于频繁的办公室访问。这种战略 对于那些能够获得一个能够提供必要探视的系统的家庭来说，这可能会成功。 然而，对许多家庭来说，频繁探视的经济或组织负担是很大的。 高其结果是，许多病人暴露在不足的门诊药物 安全监测，那些获得卫生服务最少的人可能会经历 最少的监控。PhaST系统是一种自动化系统，用于监测 药物依从性、副作用和患者症状。PhaST使用基于研究的 使用交互式语音应答（IVR）电话管理的评估程序。 当患者在IVR呼叫中报告药物问题时，PhaST会提醒 受过训练的护士对问题进行分类，为病人或家属提供咨询，必要时 联系病人吗的处方临床医生或医院急诊服务。PHAST 建立在医院数据仓库内，并与电子医疗系统完全集成。 记录和计算机化的医生订单输入系统，使临床医生有实时 病人的信息？的经验与药物。 我们的目标药物是儿科使用的抗抑郁药。越来越多地使用 儿童和青少年的精神活性药物大大增加了公众 药物相关不良事件的健康相关性，包括自杀和躁狂 activation.为了比较PhaST和常规治疗，我们提出了一项大型随机试验， 城市专业精神卫生系统主要服务于医疗补助人群。我们将 招募了800名接受新处方抗抑郁药的年轻人。我们将评估 在基线和第1、2和3个月的家庭访视期间，患者发生不良事件。我们 将比较图表记录的不良事件与确定的不良事件 被一个看不见病人的检查员s随机化。我们预测， 图表记录的不良事件和检查者确定的不良事件之间的差异， PhaST条件。我们还将比较PhaST和常规护理的措施， 患者和提供者满意度，患者结果以及 药物管理，例如患者药物不依从率。

PhaST is a health information system that assists clinicians? management of medications in ambulatory settings. PhaST seeks to protect outpatients taking drugs that have recognized side effect risks even when those drugs are correctly prescribed. Existing clinical strategies for monitoring risky drugs rely on frequent office visits. Such strategies might succeed for families with access to a system that can supply the requisite visits. However, for many families, the financial or organizational burden of frequent visits is high. The result is that many patients are exposed to inadequate outpatient medication safety monitoring, with those having least access to health services likely to experience the least monitoring. The PhaST system is an automated system for monitoring of medication adherence, side effects, and patient symptoms. PhaST uses research-based assessment procedures administered using interactive voice response (IVR) telephony. When a patient reports a problem with a medication on an IVR call, PhaST alerts a nurse trained to triage the problem, to counsel the patient or family, and when necessary to contact the patient?s prescribing clinician or the hospital emergency services. PhaST is built within a hospital data warehouse and integrates fully with the electronic medical record and computerized physician order-entry system, so clinicians have real-time information on the patient?s experience with the medication. Our target medication is the pediatric use of anti-depressants. The growing use of psychoactive medications in children and adolescents has greatly increased the public health relevance of medication-related adverse events, including suicidality and manic activation. To compare PhaST and usual care, we propose a randomized trial in a large urban specialty mental health system serving a primarily Medicaid population. We will enroll 800 youths receiving new prescriptions for anti-depressants. We will assess the patients for adverse events during home visits at baseline and 1, 2, and 3 months. We will compare chart-documented adverse events against adverse events as determined by an examiner blind to the patient?s randomization. We predict higher agreement between chart-documented adverse events and examiner-determined adverse events in the PhaST condition. We will also compare PhaST and usual care on measures of patient and provider satisfaction, patient outcomes, and measures of the quality of medication management such as rates of patient medication non-adherence.