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？浅谈药品管理 在非卧床环境中。PhaST寻求保护服用已有药物的门诊患者 公认的副作用风险，即使这些药物的处方是正确的。现有 监测高风险药物的临床策略依赖于频繁的办公室访问。这样的战略 对于能够使用能够提供必要探视的系统的家庭来说，这可能会成功。 然而，对于许多家庭来说，频繁探望的经济或组织负担是 很高。其结果是，许多患者暴露在不适当的门诊药物中 安全监测，那些获得卫生服务机会最少的人可能会经历 最少的监控。PhaST系统是一个自动化系统，用于监测 服药依从性、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会向 经过培训的护士，负责对问题进行分类，并在必要时向患者或家属提供咨询 要联系患者吗？S开的处方是临床医生还是医院急诊科。PhaST 构建在医院数据仓库中，并与电子医疗系统完全集成 记录和计算机化的医嘱录入系统，使临床医生能够实时 患者情况介绍？S用药经验。 我们的目标药物是儿科抗抑郁药的使用。越来越多的人使用 儿童和青少年的精神活性药物极大地增加了公众 与药物有关的不良事件的健康相关性，包括自杀和躁狂 激活。为了比较PhaST和常规护理，我们提出了一项大规模的随机试验 城市专业精神卫生系统主要服务于医疗补助人群。我们会 招募800名接受抗抑郁药物新处方的青年。我们将评估 患者在基线和1、2、3个月的家访期间的不良事件。我们 将图表记录的不良事件与确定的不良事件进行比较 被检查员对患者视而不见？S随机。我们预计双方会达成更高的协议 在图表记录的不良事件和审查员确定的不良事件之间 PhaST病症。我们还将比较PhaST和常规护理在以下方面的指标 患者和提供者的满意度、患者结果和质量的衡量标准 患者用药不依从率等用药管理。

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.