The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients

ChangMing, Chen; Kuo, Li-Na; Cheng, Kuei-Ju; Shen, Wan-Chen; Bai, Kuan‐Jen; Wang, Chih‐Chi; Chiang, Yi-Chun; Chen, Hsiang-Yin

doi:10.1016/j.cmpb.2016.07.008

Cited by 11 publications

(14 citation statements)

References 31 publications

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“…Most commonly, a pharmacist led (in 18 studies [32–48], while a GP and pharmacist co-led in 1 study [49], a GP alone in another study [50], a community nurse led in another study [51] and the participants themselves led in another [52]. While all interventions included a process of deprescribing, study interventions used ‘deprescribing’ specifically in nine studies [32, 35, 40, 42, 47, 48, 52, 53], while in 12 studies the description was ‘medication use review’ [33, 34, 36–38, 41, 43–46, 49–51].…”

Section: Resultsmentioning

confidence: 99%

Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review

et al. 2019

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BackgroundPolypharmacy, and the associated adverse drug events such as non-adherence to prescriptions, is a common problem for elderly people living with multiple comorbidities. Deprescribing, i.e. the gradual withdrawal from medications with supervision by a healthcare professional, is regarded as a means of reducing adverse effects of multiple medications including non-adherence. This systematic review examines the evidence of deprescribing as an effective strategy for improving medication adherence amongst older, community dwelling adults.MethodsA mixed methods review was undertaken. Eight bibliographic database and two clinical trials registers were searched between May and December 2017. Results were double screened in accordance with pre-defined inclusion/exclusion criteria related to polypharmacy, deprescribing and adherence in older, community dwelling populations. The Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal and an a priori data collection instrument was used. For the quantitative studies, a narrative synthesis approach was taken. The qualitative data was analysed using framework analysis. Findings were integrated using a mixed methods technique. The review was performed in accordance with the PRISMA reporting statement.ResultsA total of 22 original studies were included, of which 12 were RCTs. Deprescribing with adherence as an outcome measure was identified in randomised controlled trials (RCTs), observational and cohort studies from 13 countries between 1996 and 2017. There were 17 pharmacy-led interventions; others were led by General Practitioners (GP) and nurses. Four studies demonstrated an overall reduction in medications of which all studies corresponded with improved adherence. A total of thirteen studies reported improved adherence of which 5 were RCTs. Adherence was reported as a secondary outcome in all but one study.ConclusionsThere is insufficient evidence to show that deprescribing improves medication adherence. Only 13 studies (of 22) reported adherence of which only 5 were randomised controlled trials. Older people are particularly susceptible to non-adherence due to multi-morbidity associated with polypharmacy. Bio-psycho-social factors including health literacy and multi-disciplinary team interventions influence adherence. The authors recommend further study into the efficacy and outcomes of medicines management interventions. A consensus on priority outcome measurements for prescribed medications is indicated.Trial registrationPROSPERO number CRD42017075315.Electronic supplementary materialThe online version of this article (10.1186/s12877-019-1031-4) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review

et al. 2019

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“…The PharmaCloud contains the most complete and up-to-date version of a patient’s medication history. According to NHIA policy, health care facilities must upload a patient’s prescribed medications to the PharmaCloud within 24 hours after the patient’s visit [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

Yang¹,

Lo²,

Chen³

et al. 2018

JMIR Med Inform

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BackgroundA computerized physician order entry (CPOE) system combined with a clinical decision support system can reduce duplication of medications and thus adverse drug reactions. However, without infrastructure that supports patients’ integrated medication history across health care facilities nationwide, duplication of medication can still occur. In Taiwan, the National Health Insurance Administration has implemented a national medication repository and Web-based query system known as the PharmaCloud, which allows physicians to access their patients’ medication records prescribed by different health care facilities across Taiwan.ObjectiveThis study aimed to develop a scalable, flexible, and thematic design-based clinical decision support (CDS) engine, which integrates a national medication repository to support CPOE systems in the detection of potential duplication of medication across health care facilities, as well as to analyze its impact on clinical encounters.MethodsA CDS engine was developed that can download patients’ up-to-date medication history from the PharmaCloud and support a CPOE system in the detection of potential duplicate medications. When prescribing a medication order using the CPOE system, a physician receives an alert if there is a potential duplicate medication. To investigate the impact of the CDS engine on clinical encounters in outpatient services, a clinical encounter log was created to collect information about time, prescribed drugs, and physicians’ responses to handling the alerts for each encounter.ResultsThe CDS engine was installed in a teaching affiliate hospital, and the clinical encounter log collected information for 3 months, during which a total of 178,300 prescriptions were prescribed in the outpatient departments. In all, 43,844/178,300 (24.59%) patients signed the PharmaCloud consent form allowing their physicians to access their medication history in the PharmaCloud. The rate of duplicate medication was 5.83% (1843/31,614) of prescriptions. When prescribing using the CDS engine, the median encounter time was 4.3 (IQR 2.3-7.3) min, longer than that without using the CDS engine (median 3.6, IQR 2.0-6.3 min). From the physicians’ responses, we found that 42.06% (1908/4536) of the potential duplicate medications were recognized by the physicians and the medication orders were canceled.ConclusionsThe CDS engine could easily extend functions for detection of adverse drug reactions when more and more electronic health record systems are adopted. Moreover, the CDS engine can retrieve more updated and completed medication histories in the PharmaCloud, so it can have better performance for detection of duplicate medications. Although our CDS engine approach could enhance medication safety, it would make for a longer encounter time. This problem can be mitigated by careful evaluation of adopted solutions for implementation of the CDS engine. The successful key component of a CDS engine is the completeness of the patient’s medication history, thus further research to assess the f...

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“…The development of a computer‐assisted tool with automated electronic integration of patient‐based medication data was useful to accelerate the procedure of medication reconciliation, improve efficiency, and ensure that patients use medications safely . Previous research has reported that the PharmaCloud system facilitates accurate and efficient medication reconciliation by pharmacists for patients with polypharmacy (≥5 medications), to provide a medication therapy management service . The intervention in the present study successfully incorporated prescription information from the NHI PharmaCloud system into the hospital's CPOE, and assisted physicians and pharmacists to assess potential duplicate medication and ensure that medications were prescribed safely.…”

Section: Discussionmentioning

confidence: 98%

“…19 Previous research has reported that the PharmaCloud system facilitates accurate and efficient medication reconciliation by pharmacists for patients with polypharmacy (≥5 medications), to provide a medication therapy management service. 20 The intervention in the present study successfully incorporated prescription information from the NHI PharmaCloud system into the hospital's CPOE, and assisted physicians and pharmacists to assess potential duplicate medication and ensure that medications were prescribed safely.…”

Section: Thementioning

confidence: 99%

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

Hung

Chen

et al. 2019

Brit J Clinical Pharma

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Aims The aim of this study was to improve medication reconciliation and reduce the occurrence of duplicate prescriptions by pharmacists and physicians within 72 hours of hospital admission using an intelligent prescription system combined with the National Health Insurance PharmaCloud system to integrate the database with the medical institution computerized physician order entry (CPOE) system. Methods This 2‐year intervention study was implemented in the geriatric ward of a hospital in Taiwan. We developed an integrated CPOE system linked with the PharmaCloud database and established an electronic platform for coordinated communication with all healthcare professionals. Patients provided written informed consent to access their PharmaCloud records. We compared the intervention effectiveness within 72 hours of admission for improvement in pharmacist medication reconciliation, increased at‐home medications documentation and decreased costs from duplicated at‐home prescriptions. Results The medication reconciliation rate within 72 hours of admission increased from 44.0% preintervention to 86.8% postintervention (relative risk = 1.97, 95% confidence interval [CI]: 1.69–2.31; P < .001). The monthly average of patients who brought and took home medications documented in the CPOE system during hospitalization increased by 7.54 (95% CI 5.58–20.49, P = .22). The monthly average of home medications documented increased by 102.52 (95% CI 38.44–166.60; P = .01). Savings on the monthly average prescription expenditures of at‐home medication increased by US$ 2,795.52 (95% CI US$1310.41–4280.63; P < .01). Conclusion Integrating medication data from PharmaCloud to the hospital's medical chart system improved pharmacist medication reconciliation, which decreased duplicated medications and reduced in‐hospital medication costs.

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The effect of medication therapy management service combined with a national PharmaCloud system for polypharmacy patients

Cited by 11 publications

References 31 publications

Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review

Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review

A Clinical Decision Support Engine Based on a National Medication Repository for the Detection of Potential Duplicate Medications: Design and Evaluation

The impact of a medication reconciliation programme at geriatric hospital admission: A pre‐/postintervention study

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