Thursday, August 19, 2010

Another Brick in the Wall - More Evidence Provider Systems Save Lives.

Another valuable publication on E-Health Benefits.

Computerized System Can Reduce Inappropriate Medication in Hospitalized Seniors

Fran Lowry

August 9, 2010 — A computerized provider order entry (CPOE) system that uses alerts to warn when the wrong medication has been prescribed can reduce the prescription of potentially inappropriate medications (PIMs) in hospitalized older patients, according to the results of a new prospective study published in the August 9/23 issue of the Archives of Internal Medicine.

"Older people admitted to the hospital are especially vulnerable to adverse drug events (ADEs), which occur in up to 40% of hospital admissions," write Melissa L.P. Mattison, MD, from Beth Israel Deaconess Medical Center, Boston, Massachusetts, and colleagues. "Some medications may predispose vulnerable older patients to ADEs." Based on the consensus of a panel of geriatric medicine experts, a proposed list was made up of drugs were identified as medications that should be avoided in older persons. Despite the publication of this list, known as "Beers medications," "the prescription of [PIMs] to elderly patients remains common," the authors explain.

The aim of this study was to determine whether a computerized provider order entry drug warning system could decrease the number of orders for PIMs in such a population.

The authors used a prospective before-and-after design among patients aged 65 years or older admitted to their medical center from June 1, 2004, through November 29, 2004 — before the addition of the warning system — and from March 17, 2005, through August 30, 2008 — after the warning system was added.

The investigators studied the ordering patterns for 3 groups of drugs: a larger group of drugs included those on the original Beers medications list that were flagged as not to be used, a second group of Beers medications that were flagged to be used at reduced doses, and a third group of Beers medications that were not flagged.

After the warning system was deployed, there was an immediate and sustained decrease in the rate of orders for the medications that were flagged not to be used, the authors report. The mean (SE) rate of prescribing not-recommended medications dropped from 11.56 (0.36) to 9.94 (0.12) orders per day (difference, 1.62 [SE, 0.33] orders per day; P < .001). There was no evidence that this effect waned over time, the authors write.

More here (Registration Required):

http://www.medscape.com/viewarticle/726621

Again good news regarding the impact quality systems, in the hands of providers, can make to overall patient care.

As far as I know no such similar evidence exists for the Personally Controlled EHR or similar PHRs. If you know of such evidence let me know!

Well worth chasing down the original reference for the a read and the files.

David.

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