Adoption of Medication Management Technologies by U.S. Acute Care Hospitals after the HITECH Act

Medication errors and adverse drug events (ADEs) are a significant public health concern in the United States as they pose a threat to patient safety. The medication management process is a complicated process in U.S. acute care hospitals, consisting of a series of steps such as ordering, transcribing, dispensing and administration and each step is prone to medication errors.The use of technology is considered to be an important intervention in improving the medication management process and thereby reducing medication errors and ADEs and further improve patient safety. The Health Information Technology for Economic and Clinical Health (HITECH) Act, implemented in the year 2011, is the most important regulation in recent years focused on enhancing the use of IT in the health care system.This study examined the organizational and environmental correlates of the adoption of Medication Management Technologies (MMTs) by U.S. acute care hospitals after the HITECH Act. The rational adaptation perspective of the resource dependence theory is utilized in this study, using panel data from 2009 to 2013 with a one-year lag for independent variables and mixed-effects regression models for analyses. The study operationalized adoption of MMTs through seven measures: global adoption of MMTs, adoption of closed loop medication management, adoption of meaningful use MMTs and adoption-levels for the four steps of the medication management process: ordering, transcribing, dispensing and administration. Hospitals were more likely to adopt MMTs in the time after the implementation of the HITECH Act (2012, 2013) and were less likely to adopt MMTs before the implementation of the HITECH Act (2009, 2010) as compared to the HITECH Act implementation period (2011). The study further found that the resource dependence construct of munificence, operationalized through organizational size, and the construct of interdependence, operationalized through private payer mix was significantly associated with the adoption of MMTs

Information and participation in decision-making about treatment: a qualitative study of the perceptions and preferences of patients with rheumatoid arthritis.

Objectives: To elicit the perceptions and preferences of patients with rheumatoid arthritis regarding information and participation in treatment decision-making. To analyse the patients’ narratives on the background of the ethical discourse on various approaches to treatment decisionmaking. Design: In-depth interviews with themes identified using principles of grounded theory. Participants: 22 patients with long-standing rheumatoid arthritis. Main outcome measures: Qualitative data on patients’ perceptions and preferences regarding information and participation in decision-making about treatment. Results: Decision-making about treatment has been described by the patients as a process consisting of different stages with shifting loci of control and responsibility. Patients initially received one treatment recommendation and were not aware of alternative treatment options. Those participants in this study who wanted information about negative effects of a treatment cited ‘‘interest in one’s own health’’ and the potential ‘‘use of information’’ as reasons for their preference. The physicians’ expert knowledge and clinical experience regarding the effects of medication were cited as arguments by patients for a treatment recommendation. Conclusions: The patients’ accounts of decision-making about treatment differ from models of physician–patient relationship that have been put forward in ethical discourse. These differences may be relevant with respect to the starting point of an ethical analysis of treatment decision-making. Patients’ accounts with respect to a lack of information on treatment alternatives point to ethically relevant challenges regarding treatment decision-making in clinical practice

Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this record.The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.Journal of Internal MedicineKarolinska Institutet Strategic Research Area in Epidemiology (SfoEpi

Models of probabilistic category learning in Parkinson's disease: Strategy use and the effects of L-dopa

Probabilistic category learning (PCL) has become an increasingly popular paradigm to study the brain bases of learning and memory. It has been argued that PCL relies on procedural habit learning, which is impaired in Parkinson's disease (PD). However, as PD patients were typically tested under medication, it is possible that levodopa (L-dopa) caused impaired performance in PCL. We present formal models of rule-based strategy switching in PCL, to re-analyse the data from [Jahanshahi, M., Wilkinson, L, Gahir, H., Dharminda, A., & Lagnado, D.A., (2009). Medication impairs probabilistic classification learning in Parkinson's disease. Manuscript submitted for publication] comparing PD patients on and off medication (within subjects) to matched controls. Our analysis shows that PD patients followed a similar strategy switch process as controls when off medication, but not when on medication. On medication, PD patients mainly followed a random guessing strategy, with only few switching to the better Single Cue strategies. PD patients on medication and controls made more use of the optimal Multi-Cue strategy. In addition, while controls and PD patients off medication only switched to strategies which did not decrease performance, strategy switches of PD patients on medication were not always directed as such. Finally, results indicated that PD patients on medication responded according to a probability matching strategy indicative of associative learning, while the behaviour of PD patients off medication and controls was consistent with a rule-based hypothesis testing procedure. (C) 2009 Elsevier Inc. All rights reserved

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

Discusses the experiences of ten large practices earning performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries

J Am Pharm Assoc (2003)

Objectives:To (1) describe the implementation process for comprehensive medication reviews (CMRs) among community pharmacies (e.g., processes for prioritizing patients, staffing, and information collection) and (2) examine factors associated with community pharmacies\u2019 CMR information collection process.Methods:A survey was administered to the pharmacist responsible for implementation of CMRs (i.e., the lead pharmacist) in the community pharmacy (n = 87). The survey included questions about pharmacy characteristics, satisfaction with the NC community pharmacy enhanced services network (NC-CPESN) program, and implementation of CMRs. Frequencies and means were calculated to describe the sample characteristics and pharmacies\u2019 CMR implementation process. A multiple linear regression was conducted to examine which characteristics were associated with the CMR information collection process.Results:The majority of pharmacies in the sample were either independently owned single stores (46.5%) or multiple stores under the same independent ownership (41.6%). Most pharmacies used pharmacists (97.7%) or pharmacy technicians (65.5%) for patient outreach for CMRs. A small percentage of pharmacies used administrative staff to conduct patient outreach for CMRs (9.2%). Information for prescription medications (89.5%), indication (80%), and medication adherence (81.1%) was routinely collected. Information such as date of last dose for prescription medications (48.4%) and lifestyle factors, such as physical activity (21.1%), diet (29.5%), and alcohol (31.6%), was collected less routinely. Having a clinical pharmacist (P = 0.025) and pharmacist overlap hours (P = 0.009) significantly improved the CMR information collection process.Conclusion:Although CMRs are important interventions for improving patient outcomes, more guidance is needed on how to effectively implement them. This would allow the process to be efficient and assure implementation with fidelity across all community pharmacies. In addition, staffing appears to influence the quality of CMR information collection. Future research is warranted on CMR implementation to develop efficient staffing models and standardize the process of information collection.U01 CE002769/CE/NCIPC CDC HHS/United StatesUL1 TR001111/TR/NCATS NIH HHS/United States2021-05-17T00:00:00Z31405803PMC8128150972