Int J Med Inform - The effect of using the health smart card vs. CPOE reminder system on the prescribing practices of non-obstetric physicians during outpatient visits for pregnant women in Taiwan.

Tópicos

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Resumo

TRODUCTION: There is an evidence that pregnant women have been prescribed a significant number of improper medications that could lead to potential damage for a developing fetus due to discontinuity of care. The safety of pregnant women raises public concern and there is a need to identify ways to prevent potential adverse events to the pregnant woman. This study used a health smart card with a clinical reminder system to keep continuous records of general outpatient visits of pregnant women to protect them from potential adverse events caused by improper prescription.METHOD: The health smart card, issued to all 23 million citizens in Taiwan, was used to work with a Computerized Physician Order Entry (CPOE) implemented at a 700-bed teaching medical center in Taipei to provide the outpatient information of pregnant women. FDA pregnancy risk classification was used to categorize the risk of pregnant women. The log file, combined with the physicians' and patients' profiles, were statistically examined using the Mantel-Haenszel technique to evaluate the impact of system in changing physician's prescription behavior.RESULTS: A total of 441 patients ranged in age from 15 to 50 years with 1114 prescriptions involved in FDA pregnancy risk classification C, D, and X during the study period. 144 reminders (13.1%) were accepted by physicians for further assessment and 100 (69.4%) of them were modified. Non-obstetric physicians in non-emergency setting were more intended to accept reminders (27.8%, 4.9 folds than obstetricians). Reminders triggered on patients in second trimester (15.5%) were accepted by all physicians more than third trimester (OR 1.52, p<0.05).CONCLUSION: A health smart card armed with CPOE reminder system and well-defined criteria had the potential to decrease harmful medication prescribed to pregnant patients. The results show better conformance for non-obstetric physicians (26%) and when physicians accepted the alerts they are more likely to went back and review their orders (69%). In sum, reminder criteria of FDA pregnancy risk classification C for obstetricians and reminder based on different trimesters is suggested to be refined to improve system acceptability and to decrease improper prescription.

Resumo Limpo

troduct evid pregnant women prescrib signific number improp medic lead potenti damag develop fetus due discontinu care safeti pregnant women rais public concern need identifi way prevent potenti advers event pregnant woman studi use health smart card clinic remind system keep continu record general outpati visit pregnant women protect potenti advers event caus improp prescriptionmethod health smart card issu million citizen taiwan use work computer physician order entri cpoe implement bed teach medic center taipei provid outpati inform pregnant women fda pregnanc risk classif use categor risk pregnant women log file combin physician patient profil statist examin use mantelhaenszel techniqu evalu impact system chang physician prescript behaviorresult total patient rang age year prescript involv fda pregnanc risk classif c d x studi period remind accept physician assess modifi nonobstetr physician nonemerg set intend accept remind fold obstetrician remind trigger patient second trimest accept physician third trimest pconclus health smart card arm cpoe remind system welldefin criteria potenti decreas harm medic prescrib pregnant patient result show better conform nonobstetr physician physician accept alert like went back review order sum remind criteria fda pregnanc risk classif c obstetrician remind base differ trimest suggest refin improv system accept decreas improp prescript

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