Int J Med Inform - Online detection of potential duplicate medications and changes of physician behavior for outpatients visiting multiple hospitals using national health insurance smart cards in Taiwan.

Tópicos

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Resumo

JECTIVES: Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals.METHODS: A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians' behavior. Chi-square tests and two-sided z-tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months.RESULTS: The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The "Change Log" that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the "overridden" rate decreased.CONCLUSIONS: Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing.

Resumo Limpo

jectiv doctor shop hospit shop mean chang doctor hospit without profession referr similar ill condit common hong kong taiwan japan due lack infrastructur share health inform medic histori among hospit doctorshop patient like receiv duplic medic suffer advers drug reaction bureau nation health insur bnhi adopt smart card nhiic card health card taiwan nhiic card patient can freeli access differ medic institut nhiic card carri inform patient prescrib medic receiv differ hospit nationwid use system address problem duplic medic outpati visit multipl hospitalsmethod computer physician order entri cpoe system enhanc capabl access nhiic card provid alert physician system detect potenti duplic medic time prescrib physician respons alert also collect analyz chang physician behavior chisquar test twosid ztest bonferroni adjust multipl comparison use assess statist signific differ action taken physician three monthsresult enhanc cpoe system outpati servic implement instal pediatr urolog depart taipei medic univers wanfang hospit march chang log record physician behavior activ month studi period april june patient visit physician read patient nhiic card read nhiic card contain least one prescrib medic taken patient among prescript issu physician averag prescript contain least one medic might duplic prior prescript store nhiic card rate potenti duplic medic alert pediatr depart higher urolog depart versus howev rate revis prescript higher urolog depart pediatr depart overal rate physician review revis prescript rate physician review without revis prescript rate physician turn alert screen right screen pop overridden thus physician accept alert review prescript patient situat moreov studi period rate total revis made prescript increas overridden rate decreasedconclus approach enhanc capabl cpoe system use nhiic card nationwid infrastructur provid complet patient health inform medic histori share among hospit taiwan thus system can provid better prescrib tool help physician detect potenti duplic medic frequent doctorshop patient henc enhanc patient safeti across hospit boundari howev effect detect duplic medic approach much depend complet nhiic card turn primarili depend physician use card prescrib

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