14 research outputs found

    Technologies de prescription informatisée et transformation du rôle des pharmaciens communautaires

    Full text link
    L’amélioration de la qualité de l’utilisation des médicaments dans les soins primaires est devenue un enjeu crucial. Les pharmaciens communautaires se présentent comme des acteurs centraux dans l’atteinte de cet objectif, en réclamant une extension de leur rôle. L’objectif principal de cette thèse est de mieux comprendre comment les technologies de prescription informatisée (eRx) influencent la transformation du rôle des pharmaciens communautaires. Le premier article présente les résultats d’une étude de cas qui aborde la transformation du rôle des pharmaciens communautaires à partir du concept de professionnalisation. Elle propose un modèle logique des influences d’une technologie de eRx sur cette professionnalisation, élaboré à partir de la typologie de Davenport. Ce modèle logique a été validé en interviewant douze pharmaciens communautaires participant à un projet pilote typique de technologie de eRx. A partir des perceptions des pharmaciens communautaires, nous avons établi que la technologie était susceptible de soutenir la professionnalisation des pharmaciens en passant par cinq mécanismes : la capacité analytique, l’élimination des intermédiaires, l’intégration, l’automatisation et la diffusion des connaissances. Le deuxième article analyse les perturbations induites par les différentes fonctions des technologies de eRx sur la stabilité de la juridiction des pharmaciens communautaires, en se basant sur un cadre de référence adapté d’Abbott. À partir de trente-trois entrevues, avec des praticiens (médecins et pharmaciens) et des élites, cette étude de cas a permis de décrire en détail les influences des différentes fonctions sur les modalités d’action des professionnels, ainsi que les enjeux soulevés par ces possibilités. La perturbation principale est liée aux changements dans la distribution des informations, ce qui influence les activités de diagnostic et d’inférence des professionnels. La technologie peut redistribuer les informations relatives à la gestion des médicaments autant au bénéfice des médecins qu’au bénéfice des pharmaciens, ce qui suscite des tensions entre les médecins et les pharmaciens, mais aussi parmi les pharmaciens. Le troisième article présente une revue systématique visant à faire une synthèse des études ayant évalué les effets des technologies de eRx de deuxième génération sur la gestion des médicaments dans les soins primaires. Cette revue regroupe dix-neuf études menées avec des méthodes observationnelles. Les résultats rapportés révèlent que les technologies sont très hétérogènes, le plus souvent immatures, et que les effets ont été peu étudiés au-delà des perceptions des utilisateurs, qui sont mitigées. Le seul effet positif démontré est une amélioration de la qualité du profil pharmacologique accessible aux professionnels, alors que des effets négatifs ont été démontrés au niveau de l’exécution des prescriptions, tels que l’augmentation du nombre d’appels de clarification du pharmacien au prescripteur. Il semble donc que l’on en connaisse peu sur les effets des technologies de eRx de deuxième génération. Ces trois études permettent de constater que les nouvelles technologies de eRx peuvent effectivement influencer la transformation du rôle du pharmacien communautaire en perturbant les caractéristiques des prescriptions, et surtout, l’information et sa distribution. Ces perturbations génèrent des possibilités pour une extension du rôle des pharmaciens communautaires, tout en soulignant les défis intra et interprofessionnels associés à l’actualisation de ces possibilités. Dans l’ensemble, nos résultats soulignent que les perturbations associées aux technologies de eRx dépassent les éléments techniques du travail des utilisateurs, pour englober de multiples perturbations quant à la nature même du travail et du rôle des professionnels. Les décideurs et acteurs impliqués dans le déploiement des technologies de eRx auraient avantage à prendre en compte l’ensemble de ces considérations pour rapprocher les effets observés des bénéfices promis de ces technologies.The quality of medication use in primary care needs to improve: this has become a crucial issue. Community pharmacists want to play a key role in meeting this objective and are calling for an expanded role. The main objective of this thesis is to better understand how electronic prescription (eRx) technologies are influencing the transformation of the role played by community pharmacists. The first article presents results from a case study on the transformation of the community pharmacists’ role, based on the concept of professionalization. It proposes a logical model of how an eRx technology influences this professionalization, developed from the Davenport typology. The logical model was validated by interviewing twelve community pharmacists participating in a typical pilot project involving an eRx technology. Based on the perceptions of community pharmacists, we have determined that there are five mechanisms by which the technology is likely to support the professionalization of pharmacists: analytic capacity, the elimination of intermediaries, integration, automation and the dissemination of knowledge. The second article analyzes the disturbances produced by the various functions of eRx technologies on the jurisdiction of community pharmacists, based on an adaptation of Abbott’s model. Using data from 33 interviews with practitioners, physicians and pharmacists, as well as elite members of these two professions, this case study provides a detailed description of how different functions influence professionals’ modalities of action, as well as the issues raised by these possibilities. The primary disturbance is associated with changes in the distribution of information, which can influence the diagnostic and inference activities of professionals. The technology may redistribute information on the management of medication to the benefit of both physicians and pharmacists, and this creates tensions, not only between physicians and pharmacists but also among pharmacists. The third article presents a systematic review that synthesized studies assessing the impacts of second-generation eRx technologies on the management of medication in primary care. It examined 19 studies that applied observational methods. The findings reveal that the technologies are very heterogeneous and often far from mature, and that their effects received little attention beyond the perceptions of users, which were mixed. The only positive impact shown is an improvement to the quality of the pharmacological profile available to professionals. Negative impacts touched on the execution of prescriptions, such as a greater number of calls from pharmacists to prescribers to clarify information. It would therefore appear that little is known about the impacts of second-generation eRx technologies. These three studies allow us to conclude that new eRx technologies may well influence how the role of the community pharmacist is being transformed, specifically by disturbing the characteristics of prescriptions and, above all, information and its distribution. These disturbances generate opportunities for extending the role of community pharmacists, while underscoring the intra and interprofessional challenges associated with their realization. Overall, our results suggest that the disturbances associated with eRx technologies go beyond technical aspects of users’ work, to include multiple disturbances of the very nature of the professionals’ work and role. The decision makers and actors involved in deploying eRx technologies would be well advised to take all these considerations into account to bring the observed effects of these technologies more in line with their promised benefits

    Impact of electronic medical record on physician practice in office settings: a systematic review

    Get PDF
    <p>Abstract</p> <p>Background</p> <p>Increased investments are being made for electronic medical records (EMRs) in Canada. There is a need to learn from earlier EMR studies on their impact on physician practice in office settings. To address this need, we conducted a systematic review to examine the impact of EMRs in the physician office, factors that influenced their success, and the lessons learned.</p> <p>Results</p> <p>For this review we included publications cited in Medline and CINAHL between 2000 and 2009 on physician office EMRs. Studies were included if they evaluated the impact of EMR on physician practice in office settings. The Clinical Adoption Framework provided a conceptual scheme to make sense of the findings and allow for future comparison/alignment to other Canadian eHealth initiatives.</p> <p>In the final selection, we included 27 controlled and 16 descriptive studies. We examined six areas: prescribing support, disease management, clinical documentation, work practice, preventive care, and patient-physician interaction. Overall, 22/43 studies (51.2%) and 50/109 individual measures (45.9%) showed positive impacts, 18.6% studies and 18.3% measures had negative impacts, while the remaining had no effect. Forty-eight distinct factors were identified that influenced EMR success. Several lessons learned were repeated across studies: (a) having robust EMR features that support clinical use; (b) redesigning EMR-supported work practices for optimal fit; (c) demonstrating value for money; (d) having realistic expectations on implementation; and (e) engaging patients in the process.</p> <p>Conclusions</p> <p>Currently there is limited positive EMR impact in the physician office. To improve EMR success one needs to draw on the lessons from previous studies such as those in this review.</p

    The Development and Evaluation of an Integrated Electronic Prescribing and Drug Management System for Primary Care

    No full text
    Objective: To develop and evaluate the acceptability and use of an integrated electronic prescribing and drug management system (MOXXI) for primary care physicians. Design: A 20-month follow-up study of MOXXI (Medical Office of the XXIst Century) implementation in 28 primary care physicians and 13,515 consenting patients. Measurement: MOXXI was developed to enhance patient safety by integrating patient demographics, retrieving active drugs from pharmacy systems, generating an automated problem list, and providing electronic prescription, stop order, automated prescribing problem alerts, and compliance monitoring functions. Evaluation of technical performance, acceptability, and use was conducted using audit trails, questionnaires, standardized tasks, and information from comprehensive health insurance databases. Results: Perceived improvements in continuity of care and professional autonomy were associated with physicians' expected use of MOXXI. Physician speed in using MOXXI improved substantially in the first three months; however, only the represcribing function was faster using MOXXI than by handwritten prescription. Physicians wrote electronic prescriptions in 36.9 per 100 visits and reviewed the patient's drug profile in 12.6 per 100 visits. Physicians rated printed prescriptions, the current drug list, and the represcribing function as the most beneficial aspects of the system. Physicians were more likely to use the drug profile for patients who used more medication, made more emergency department visits, had more prescribing physicians, and lower continuity of care. Conclusion: Primary care physicians believed an integrated electronic prescribing and drug management system would improve continuity of care, and they were more likely to use the system for patients with more complex, fragmented care

    Assessing the potential of national strategies for electronic health records for population health monitoring and research

    Get PDF
    "Initiated in October 2004, this project builds upon two previous reports that portray a new landscape for health statistics: Shaping a Health Statistics Vision for the 21st Century: The Final Report, a joint report developed by the National Committee on Vital and Health Statistics, the Centers for Disease Control and Prevention's National Center for Health Statistics, and the U.S. Department of Health and Human Services' Data Council (Friedman, Hunter, Parrish 2002); and Information for Health: A Strategy for Building the National Health Information Infrastructure, a report released by the National Committee on Vital and Health Statistics (2001)." - p. 1"The purpose of this report is to assess the potential of national strategies for electronic health records for population health monitoring and research. The emphasis in this report is upon those types of population health monitoring typically used to develop health statistics, such as population-based registries, population-based surveys, and administrative health data, rather than those types of population health monitoring used to detect health events and diseases for the purposes of immediate public health interventions. More specifically, this report has a fourfold purpose: first, to describe the current status of national strategies for electronic health records and their supporting national health information infrastructures in Australia, Canada, England, and New Zealand, especially as those national strategies relate to population health monitoring to produce health statistics and research employing health statistics; second, to summarize themes about the potential contributions, and barriers to those contributions, of national strategies for electronic health records for population health monitoring and research and barriers that emerged from key informant interviews with experts in the same four countries; third to summarize themes emerging from key informant interviews with U.S. experts; and fourth, to delineate major fundamental issues in the relationship between national strategies for electronic health records and population health and monitoring." -.p. 1-21. Introduction -- 2. Methods -- 3. Factors impacting on national strategies for electronic health records -- 4. Nation snapshots: Australia, Canada, England, and New Zealand -- 5. Common themes in interviews with expert informants in Australia, Canada, England, and New Zealand -- 6. Common themes in interviews with expert informants in the U.S. -- 7. Fundamental issues in the relationship of national strategies for electronic health records to population health monitoring and research -- References -- Acronyms and glossary -- Tables -- Figures -- Appendix 1. Structured search criteria -- Appendix 2. Journals and newsletters reviewed -- Appendix 3.Typical interview guide (English expert) -- Appendix 4. Key informants"January 2006."Author: Daniel J. Friedman, Population and Public Health Information Services.Also available via the World Wide Web.Includes bibliographical references (p. 61-70)

    ETSU Medical Residents\u27 Clinical Information Behaviors, Skills, Training, and Resource Use.

    Get PDF
    Information is a powerful tool for enabling physicians to provide quality healthcare for their patients. Information use in the clinic is a skill that must be learned. If medical residency programs fail to impart this skill, then patients will suffer. The residents of the ETSU Quillen College of Medicine were surveyed as to their use of clinical information. Of the 217 residents of the 2005-2006 class who were surveyed, 105 returned the survey for a return rate of 48%. The clinical faculty was also surveyed in order to measure the responses of the residents against that of their instructors. ETSU residents frequently had a new information need in the clinic. The majority of the time they did not seek an answer, but when they did they were often successful in finding an answer. Therapy information was the most frequently sought after type of information. Most residents used the Quillen College of Medicine Library, but not at a desirable rate. Residents stated that information obtained from the library was helpful in caring for their patients. The most frequent source of information used by residents was electronic resources and the greatest barrier to the use of information was time. The majority of residents were PDA users, with Palm devices being the primary platform. The residents rated their PDA skills and evidence-based medicine skills as above average. Few were LoansomeDoc users. The majority of residents received information training from clinical faculty and from librarians and rated it highly. Residents indicated a desire for more training and the majority indicated that they would like a clinical medical librarian for their program. They rated the library service of the Quillen College of Medicine and the area teaching hospitals highly. Residents used Google and the Web frequently. PubMed was rated as a valuable resource. Online journals and the UpToDate database were important electronic resources for the residents. ETSU residents have many excellent resources and training opportunities in place. However, for ETSU residents to go out into community practice as true Infomasters an upgrading of their information training should be undertaken

    Use of primary care data for identifying individuals at risk of cardiovascular disease

    Get PDF
    The aim of this research was to explore the potential of routinely collected primary care data to support the identification of individuals for cardiovascular risk reduction. The work involved a systematic literature review of reminder interventions operating at the point of care; a randomised controlled trial of a novel software tool to facilitate the targeting of individuals at risk of cardiovascular disease; and an exploration of qualitative issues relevant to the challenge of cardiovascular risk reduction in current practice. The Systematic review resulted in a narrative synthesis and a meta-analysis. It concluded that reminder interventions are generally effective at changing practitioner behaviour, but the effect is inconsistent, probably dependent on organisational context, and difficult to predict. The e-Nudge trial involved 19 practices in Coventry and Warwickshire, who used the e-Nudge software tool for two years. This tool was programmed for the project by the clinical software company EMIS. Whilst the primary outcome (cardiovascular event rate) was not significantly reduced in this timescale, a beneficial effect was demonstrated on the adequacy of data to support risk estimation and on the visibility of the at risk population. A new means of addressing the problem of undiagnosed and late-diagnosed diabetes was also discovered. Qualitative aspects of this area of care are presented through a discussion of ethical issues, a limited series of interviews with members of the public included in the appendix, and extensive field notes taken throughout the research. These provide some context in support of the e-Nudge trial. Routinely collected data of UK general practice provide a potentially rich resource to support primary cardiovascular disease prevention, but practical, ethical and conceptual issues must all be addressed to optimise their impact. This conclusion forms the thesis to be explored and justified through this dissertation
    corecore