Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

Bhat, Shubha; Derington, Catherine G.; Trinkley, Katy E.

doi:10.1055/s-0040-1712467

Cited by 9 publications

(12 citation statements)

References 43 publications

(50 reference statements)

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“…Clinician informational needs and preferences for CDS design is important to optimize acceptance and adherence to CDS recommendations. [26][27][28][29][30] Finally, the relative risk calculations for diLQTS in this investigation were conducted broadly at the drug level across all patients, ignoring the specific patient-level information that may have placed a given patient at greater or lesser risk of diLQTS. Accurate risk prediction of diLQTS is an active area of research in our group, and we anticipate that with improved prediction modeling, a more accurate risk assessment could both improve accuracy of CDS alerts, as well as provide more meaningful guidance for providers at the time of prescription.…”

Section: Limitationsmentioning

confidence: 99%

Assessing Prescriber Behavior with a Clinical Decision Support Tool to Prevent Drug-Induced Long QT Syndrome

et al. 2021

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Objective Clinical decision support (CDS) alerts built into the electronic health record (EHR) have the potential to reduce the risk of drug-induced long QT syndrome (diLQTS) in susceptible patients. However, the degree to which providers incorporate this information into prescription behavior and the impact on patient outcomes is often unknown. Methods We examined provider response data over a period from October 8, 2016 until November 8, 2018 for a CDS alert deployed within the EHR from a 13-hospital integrated health care system that fires when a patient with a QTc ≥ 500 ms within the past 14 days is prescribed a known QT-prolonging medication. We used multivariate generalized estimating equations to analyze the impact of therapeutic alternatives, relative risk of diLQTS for specific medications, and patient characteristics on provider response to the CDS and overall patient mortality. Results The CDS alert fired 15,002 times for 7,510 patients for which the most common response (51.0%) was to override the alert and order the culprit medication. In multivariate models, we found that patient age, relative risk of diLQTS, and presence of alternative agents were significant predictors of adherence to the CDS alerts and that nonadherence itself was a predictor of mortality. Risk of diLQTS and presence of an alternative agent are major factors in provider adherence to a CDS to prevent diLQTS; however, provider nonadherence was associated with a decreased risk of mortality. Conclusion Surrogate endpoints, such as provider adherence, can be useful measures of CDS value but attention to hard outcomes, such as mortality, is likely needed.

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Section: Limitationsmentioning

confidence: 99%

Assessing Prescriber Behavior with a Clinical Decision Support Tool to Prevent Drug-Induced Long QT Syndrome

et al. 2021

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“… 80 , 81 Patients may not discuss cost unless asked, 82 such as when providers note adherence problems. 23 , 60 Similarly, we found that information about challenges might be elicited only after prescriptions went unfilled. However, some providers reported surfacing cost barriers by routinely asking about cost concerns, particularly those working in the 8 clinical settings that had implemented SDOH screening programs.…”

Section: Discussionmentioning

confidence: 55%

“…Furthermore, although new tools such as RTBTs may address prescribers’ desires for point-of-care tools to recommend alternatives, 60 there has been little attention to the needs and perspectives of a range of providers engaged with addressing patients’ medication affordability challenges, such as pharmacists, nurses, social workers, and advanced practice providers, in designing such tools. Pharmacists assist patients in identifying cost-effective insurance plans 61 , 62 and selecting lower-cost medications.…”

Section: Introductionmentioning

confidence: 99%

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

et al. 2022

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Objective To explore diverse provider perspectives on: strategies for addressing patient medication cost barriers; patient medication cost information gaps; current medication cost-related informatics tools; and design features for future tool development. Materials and Methods We conducted 38 semistructured interviews with providers (physicians, nurses, pharmacists, social workers, and administrators) in a Midwestern health system in the United States. We used 3 rounds of qualitative coding to identify themes. Results Providers lacked access to information about: patients’ ability to pay for medications; true costs of full medication regimens; and cost impacts of patient insurance changes. Some providers said that while existing cost-related tools were helpful, they contained unclear insurance information and several questioned the information’s quality. Cost-related information was not available to everyone who needed it and was not always available when needed. Fragmentation of information across sources made cost-alleviation information difficult to access. Providers desired future tools to compare medication costs more directly; provide quick references on costs to facilitate clinical conversations; streamline medication resource referrals; and provide centrally accessible visual summaries of patient affordability challenges. Discussion These findings can inform the next generation of informatics tools for minimizing patients’ out-of-pocket costs. Future tools should support the work of a wider range of providers and situations and use cases than current tools do. Such tools would have the potential to improve prescribing decisions and better link patients to resources. Conclusion Results identified opportunities to fill multidisciplinary providers’ information gaps and ways in which new tools could better support medication affordability for patients.

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“…We designed the alerts to be actionable, provide alternatives, include standardized text, and display at medication selection instead of order signing. 15,16 The prescriber was then allowed to select one of the suggested alternatives, continue with the original order, or cancel the order (►Fig. 1).…”

Section: Methodsmentioning

confidence: 99%

Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems

et al. 2020

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Background The American Geriatrics Society recommends against the use of certain potentially inappropriate medications (PIMs) in older adults. Prescribing of these medications correlates with higher rates of hospital readmissions, morbidity, and mortality. Vanderbilt University Medical Center previously deployed clinical decision support (CDS) to decrease PIM prescribing rates, but recently transitioned to a new electronic health record (EHR). Objective The goal of this study was to evaluate PIM prescribing rates for older adults before and after migration to the new EHR system. Methods We reviewed prescribing rates of PIMs in adults 65 years and older, normalized per 100 total prescriptions from the legacy and new EHR systems between July 1, 2014 and December 31, 2019. The PIM prescribing rates before and after EHR migration during November 2017 were compared using a U-chart and Poisson regression model. Secondary analysis descriptively evaluated the frequency of prescriber acceptance rates in the new EHR. Results Prescribing rates of PIMs decreased 5.2% (13.5 per 100 prescriptions to 12.8 per 100 prescriptions; p < 0.0001) corresponding to the implementation of alternatives CDS in the legacy EHR. After migration of the alternative CDS from the legacy to the new EHR system, PIM prescribing rates dropped an additional 18.8% (10.4 per 100 prescriptions; p < 0.0001). Acceptance rates of the alternative recommendations for PIMs was low overall at 11.1%. Conclusion The prescribing rate of PIMs in adults aged 65 years and older was successfully decreased with the implementation of prescribing CDS. This decrease was not only maintained but strengthened by the transition to a new EHR system.

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Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

Cited by 9 publications

References 43 publications

Assessing Prescriber Behavior with a Clinical Decision Support Tool to Prevent Drug-Induced Long QT Syndrome

Assessing Prescriber Behavior with a Clinical Decision Support Tool to Prevent Drug-Induced Long QT Syndrome

Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want

Reducing Inappropriate Outpatient Medication Prescribing in Older Adults across Electronic Health Record Systems

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