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首页> 外文期刊>Clinical Interventions in Aging >Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention
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Physicians’ use of computerized clinical decision supports to improve medication management in the elderly – the Seniors Medication Alert and Review Technology intervention

机译：医生使用计算机化的临床决策支持来改善老年人的药物管理-老年人用药预警和审查技术干预

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Background: Elderly people (aged 65 years or more) are at increased risk of polypharmacy (five or more medications), inappropriate medication use, and associated increased health care costs. The use of clinical decision support (CDS) within an electronic medical record (EMR) could improve medication safety. Methods: Participatory action research methods were applied to preproduction design and development and postproduction optimization of an EMR-embedded CDS implementation of the Beers’ Criteria for medication management and the Cockcroft–Gault formula for estimating glomerular filtration rates (GFR). The “Seniors Medication Alert and Review Technologies” (SMART) intervention was used in primary care and geriatrics specialty clinics. Passive (chart messages) and active (order-entry alerts) prompts exposed potentially inappropriate medications, decreased GFR, and the possible need for medication adjustments. Physician reactions were?assessed using surveys, EMR simulations, focus groups, and semi-structured interviews. EMR audit data were used to identify eligible patient encounters, the frequency of CDS events, how alerts were managed, and when evidence links were followed. Results: Analysis of subjective data revealed that most clinicians agreed that CDS appeared at appropriate times during patient care. Although managing alerts incurred a modest time burden, most also agreed that workflow was not disrupted. Prevalent concerns related to clinician accountability and potential liability. Approximately 36% of eligible encounters triggered at least one SMART alert, with GFR alert, and most frequent medication warnings were with hypnotics and anticholinergics. Approximately 25% of alerts were overridden and ~15% elicited an evidence check. Conclusion: While most SMART alerts validated clinician choices, they were received as valuable reminders for evidence-informed care and education. Data from this study may aid other attempts to implement Beers’ Criteria in ambulatory care EMRs.
机译：背景：老年人（65岁或65岁以上）的多药房风险（五种或更多药物），药物使用不当以及相关的医疗保健费用增加。在电子病历（EMR）中使用临床决策支持（CDS）可以提高药物安全性。方法：将参与性行动研究方法应用于啤酒的《啤酒标准》和Cockcroft-Gault公式用于估计肾小球滤过率（GFR）的EMR嵌入CDS实施的生产前设计，开发和生产后优化。基层医疗和老年病专科诊所使用了“高级药物预警和审查技术”（SMART）干预措施。被动（图表消息）和主动（订单输入警报）提示暴露了可能不适当的药物，GFR降低以及可能需要调整药物。使用调查，EMR模拟，焦点小组和半结构化访谈来评估医师的反应。 EMR审核数据用于识别符合条件的患者，CDS事件发生的频率，警报的管理方式以及何时遵循证据链接。结果：主观数据分析表明，大多数临床医生都认为CDS在患者护理期间的适当时间出现。尽管管理警报会产生适度的时间负担，但大多数人也认为工作流不会中断。与临床医生的责任感和潜在责任有关的普遍关注。约有36％的符合条件的相遇事件触发了至少一项SMART警报和GFR警报，最常见的药物警告是催眠药和抗胆碱能药。大约25％的警报被覆盖，约15％的警报引起了证据检查。结论：尽管大多数SMART警报均能验证临床医生的选择，但它们被视为对循证知情的护理和教育的宝贵提醒。这项研究得出的数据可能会有助于其他尝试，以在非卧床医疗电子病历中实施比尔斯标准。

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