How the presentation of patient information and decision-support advisories influences opioid prescribing behavior: A simulation study

ObjectiveThe United States faces an opioid crisis. Integrating prescription drug monitoring programs into electronic health records offers promise to improve opioid prescribing practices. This study aimed to evaluate 2 different user interface designs for prescription drug monitoring program and electronic health record integration.Materials and MethodsTwenty-four resident physicians participated in a randomized controlled experiment using 4 simulated patient cases. In the conventional condition, prescription opioid histories were presented in tabular format, and computerized clinical decision support (CDS) was provided via interruptive modal dialogs (ie, pop-ups). The alternative condition featured a graphical opioid history, a cue to visit that history, and noninterruptive CDS. Two attending pain specialists judged prescription appropriateness.ResultsParticipants in the alternative condition wrote more appropriate prescriptions. When asked after the experiment, most participants stated that they preferred the alternative design to the conventional design.ConclusionsHow patient information and CDS are presented appears to have a significant influence on opioid prescribing behavior

The Business Case for Quality: Ending Business as Usual in American Health Care

Examines some of the reasons why establishing a business case for improving health care is so difficult, and considers possible solutions. Includes comments on quality provisions of the Medicare Prescription Drug Improvement and Modernization Act of 2003

IT-based Patient Interventions for Opioid Abuse: Evaluation using Analytical Model

The number of people in the US with opioid abuse exceeds 2 million and the total cost is approximately $100B per year. In this study, we focus on patient-level interventions and present three IT-based interventions: (a) mobile reminders, (b) electronic monitoring, and (c) composite intervention. We have developed an analytical model for evaluating interventions using Return-on-Investment (ROI). The interventions are cost-effective for higher values of intervention effectiveness, hospital, and emergency room cost. However, with QoL improvement, cost-effectiveness improves significantly. We also explored the use of financial incentives for increasing the adoption of interventions. These results will help patients, healthcare professionals, decision-makers, and family members to choose the most suitable intervention to address opioid abuse

Drug prescription support in dental clinics through drug corpus mining

The rapid increase in the volume and variety of data poses a challenge to safe drug prescription for the dentist. The increasing number of patients that take multiple drugs further exerts pressure on the dentist to make the right decision at point-of-care. Hence, a robust decision support system will enable dentists to make decisions on drug prescription quickly and accurately. Based on the assumption that similar drug pairs have a higher similarity ratio, this paper suggests an innovative approach to obtain the similarity ratio between the drug that the dentist is going to prescribe and the drug that the patient is currently taking. We conducted experiments to obtain the similarity ratios of both positive and negative drug pairs, by using feature vectors generated from term similarities and word embeddings of biomedical text corpus. This model can be easily adapted and implemented for use in a dental clinic to assist the dentist in deciding if a drug is suitable for prescription, taking into consideration the medical profile of the patients. Experimental evaluation of our model’s association of the similarity ratio between two drugs yielded a superior F score of 89%. Hence, such an approach, when integrated within the clinical work flow, will reduce prescription errors and thereby increase the health outcomes of patients

Drug prescription support in dental clinics through drug corpus mining

The rapid increase in the volume and variety of data poses a challenge to safe drug prescription for the dentist. The increasing number of patients that take multiple drugs further exerts pressure on the dentist to make the right decision at point-of-care. Hence, a robust decision support system will enable dentists to make decisions on drug prescription quickly and accurately. Based on the assumption that similar drug pairs have a higher similarity ratio, this paper suggests an innovative approach to obtain the similarity ratio between the drug that the dentist is going to prescribe and the drug that the patient is currently taking. We conducted experiments to obtain the similarity ratios of both positive and negative drug pairs, by using feature vectors generated from term similarities and word embeddings of biomedical text corpus. This model can be easily adapted and implemented for use in a dental clinic to assist the dentist in deciding if a drug is suitable for prescription, taking into consideration the medical profile of the patients. Experimental evaluation of our model’s association of the similarity ratio between two drugs yielded a superior F score of 89%. Hence, such an approach, when integrated within the clinical work flow, will reduce prescription errors and thereby increase the health outcomes of patients

Community Pharmacy: an untapped patient data resource

As community pharmacy services become more patient centred they will be increasingly reliant on access to good quality patient information. This paper describes how the information which is currently available in community pharmacies can be used to enhance service delivery and patient care. With integration of community pharmacy and medical practice records on the horizon the opportunities this will provide are also considered. The community pharmacy held patient medication record, which is the central information repository, has been used to identify non-adherence, to prompt the pharmacist to clinically review prescriptions, identify patients for additional services and to identify those patients at greater risk of adverse drug events. Whilst active recording of patient consultations for treatment over the counter may improve the quality of consultations and information held, the lost benefits of anonymity afforded by community pharmacies needs to be considered. Recording of pharmacy staff activities enables workload to be monitored, remuneration to be justified and critical incidents to be learned from but is not routine practice. Centralisation of records between community pharmacies enables practices to be compared and consistent problems to be identified. By integrating pharmacy and medical practice records, patient behaviour with respect to medicines can be more closely monitored and should prevent duplication of effort. When using patient information stored in a community pharmacy it is however important to consider the reason why information was recorded in the first instance and whether it is appropriate to use it for a different purpose without additional patient consent. Community pharmacies currently have access to large amounts of information which if stored and used appropriately can significantly enhance the quality of provided services and patient care. Integrating records increases opportunities to enhance patient care yet further. Whilst community pharmacies have significant amounts of information available to them this is frequently untapped

Consumer-Directed Health Care: Can Consumers Look After Themselves?

In health care systems today, including those of Switzerland and the United States, participants do not necessarily see the big picture of lifetime health costs and quality of life, and in many systems consumers and providers lack the incentives to manage preventative and chronic care to minimize lifetime private and social health costs. Resource allocation problems induced by asymmetric information and misaligned incentives are exacerbated if consumers fail to have the acuity or perspective needed to make choices consistent with their self-interest when faced with complex health care choices with ambiguous future consequences. This paper examines rationality of consumers’ health perceptions and choices using as a natural experiment the recent introduction in the United States of a highly subsidized market for prescription drug insurance, and draws lessons from this experiment on the practicality of “Consumer Directed Health Care” as an approach to achieving efficient allocation of health care resources by confronting consumers with the full marginal costs of the services they use

Ranking the harm of non-medically used prescription opioids in the UK

A panel of nine experts applied multi-criteria decision analysis (MCDA) to determine the relative overall harm to users and harms to others of street heroin (injected and smoked) and eleven non-medically used prescription opioids. The experts assessed harm scores for each of the 13 opioids on each of 20 harm criteria, weighted the criteria and explored the resulting weighted harm scores for each opioid. Both forms of heroin scored very high: overall harm score of 99 for injected heroin and 72 for smoked heroin on a scale of 0–100. The main feature that distinguishes both forms of street heroin use is that their harm to others is more than five times that of the other eleven opioids. The overall harm score of fentanyl (including injection of fentanyl extracted from patches) and diamorphine (medically prescribed form of heroin) was 54 and 51, respectively, whereas that of orally used opioids ranged from 32 (pethidine) to 11 (codeine-containing pharmaceuticals). Injected street heroin, fentanyl and diamorphine emerged as most harmful to users, with the latter two very low in harm to others. Pethidine, methadone, morphine and oxycodone are also low in harm to others, while moderate in harm to users. We conclude that the overall harms of non-medically used prescription opioids are less than half that of injected street heroin. These data may give a basis for precautionary regulatory measures that should be considered if the rising trend in non-medical use of prescription opioids were to become evident in the UK