Physicians' reported needs of drug information at point of care in Sweden

Abstract

Keywordsdecision support systems, drug information, drug labelling, focus group discussions, health services needs and demand, medical informatics ---------------------------------------------------------------------- WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• The computerization of health care has increased dramatically in the last decades in most European countries, but no standardization of any of the information support systems has been established on common ground. • The Summary of Product Characteristics (SmPC) is available all over Europe in written form and in some of the countries even electronically, but the structure and the content of the information vary.• The physicians' needs for useful and reliable information about drugs at point of care are a question of patient safety. WHAT THIS STUDY ADDS• A qualitative approach, in this case focus group discussions, proved advantagous compared with questionnaires. • Knowledge gained from physicians' experiences promoted the work of restructuring and organizing the e-SmPC database.• Most of the required information from physicians appeared to be possible to transfer from current SmPCs to clinical decisions support systems. AIMSRelevant and easily accessible drug information at point-of-care is essential for physicians' decision making when prescribing. However, the information available by using Clinical Decision Support Systems (CDSSs) often does not meet physicians' requirements. The Summary of Product Characteristics (SmPC) is statutory information about drugs. However, the current structure, content and format of SmPCs make it difficult to incorporate them into CDSSs and link them to relevant patient information from the Electronic Health Records. The aim of the study was to evaluate the perceived needs for drug information among physicians in Sweden. METHODSWe recruited three focus group discussions with 18 physicians covering different specialities. The information from the groups was combined with a questionnaire administered at the beginning of the group discussions. RESULTSPhysicians reported their needs for knowledge databases at the point of drug prescribing. This included more consistent information about existing and new drugs. They also wished to receive automatically generated alerts for severe drug-drug interactions and adverse effects, and to have functions for calculating glomerular filtration rate to enable appropriate dose adjustments to be made for elderly patients and those with impaired renal function. Additionally, features enhancing electronic communication with colleagues and making drug information more searchable were suggested. CONCLUSIONSThe results from the current study showed the need for knowledge databases which provide consistent information about new and existing drugs. Most of the required information from physicians appeared to be possible to transfer from current SmPCs to CDSSs. However, inconsistencies in the SmPC information have to be reduced to enhance their utility.

Shaping medicinal product information: a before and after study exploring physicians’ perspectives on the summary of product characteristics

“…These hamper readability and usability and render the officially approved information on a medicinal product (SmPCs), a document with only limited relevance in practice. Comparable findings which identified the current structure as a major drawback of SmPCs were illustrated in a study involving Swedish physicians 20. On the basis of the findings, an alternative SmPC was created.…”

“…It was found that the interactions were properly included in the SmPCs related to the originator product but were not (yet) considered in the SmPCs related to some generic products 18. Computerised systems of information on medicinal products integrated in prescribing systems have successfully been introduced in some countries, for example, in the Anglo-American regions, but such systems are not standard practice 19 20…”

Potential drug-related problems detected by electronic expert support system: physicians’ views on clinical relevance

“…However, drugs frequently cause side effects and drug related problems (DRPs) are a common cause for patients' suffering and substantial costs for society [1][2][3][4]. A significant part of DRPs can be prevented if health care personnel and patients have the necessary knowledge or information in a usable form when needed [5][6][7]. This includes patient specific information such as the patients' current medication list and other patient specific parameters such as medical conditions, laboratory values, or other factors influencing drug intake and metabolism.…”

Comparative evaluation of different medication safety measures for the emergency department: physicians’ usage and acceptance of training, poster, checklist and computerized decision support

“…Posters, for example were not visible from all treatment cubicles. The fact that limited availability at the point of care impedes usage behavior was also reported by Rahmner et al [47]. In contrast to posters, checklists were directly available but were rarely applied, because of physicians’ habit of using the “Arzneimittel pocket” (a German pocket drug reference).…”