Assessment of ePrescription quality: an observational study at three mail-order pharmacies

<p>Abstract</p> <p>Background</p> <p>The introduction of electronic transfer of prescriptions (ETP) or ePrescriptions in ambulatory health care has been suggested to have a positive impact on the prescribing and dispensing processes. Thereby, implying that ePrescribing can improve safety, quality, efficiency, and cost-effectiveness. In December 2007, 68% of all new prescriptions were transferred electronically in Sweden. The aim of the present study was to assess the quality of ePrescriptions by comparing the proportions of ePrescriptions and non-electronic prescriptions necessitating a clarification contact (correction, completion or change) with the prescriber at the time of dispensing.</p> <p>Methods</p> <p>A direct observational study was performed at three Swedish mail-order pharmacies which were known to dispense a large proportion of ePrescriptions (38–75%). Data were gathered on all ePrescriptions dispensed at these pharmacies over a three week period in February 2006. All clarification contacts with prescribers were included in the study and were classified and assessed in comparison with all drug prescriptions dispensed at the same pharmacies over the specified period.</p> <p>Results</p> <p>Of the 31225 prescriptions dispensed during the study period, clarification contacts were made for 2.0% (147/7532) of new ePrescriptions and 1.2% (79/6833) of new non-electronic prescriptions. This represented a relative risk (RR) of 1.7 (95% CI 1.3–2.2) for new ePrescriptions compared to new non-electronic prescriptions. The increased RR was mainly due to 'Dosage and directions for use', which had an RR of 7.6 (95% CI 2.8–20.4) when compared to other clarification contacts. In all, 89.5% of the suggested pharmacist interventions were accepted by the prescriber, 77.7% (192/247) as suggested and an additional 11.7% (29/247) after a modification during contact with the prescriber.</p> <p>Conclusion</p> <p>The increased proportion of prescriptions necessitating a clarification contact for new ePrescriptions compared to new non-electronic prescriptions indicates the need for an increased focus on quality aspects in ePrescribing deployment. ETP technology should be developed towards a two-way communication between the prescriber and the pharmacist with automated checks of missing, inaccurate, or ambiguous information. This would enhance safety and quality for the patient and also improve efficiency and cost-effectiveness within the health care system.</p

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Drivers of change in fragile environments: Challenges to governance in Indian wetlands

In densely populated coastal wetlands with rich biodiversity, multiple, but generally competing, economic activities are common. This paper adopts a polycentric perspective to the study of wetlands management in India to assess the scope for sustainable and equitable use of these remarkable and threatened ecosystems. The analytical framework proves to be useful and highlights that the intertwined processes of environmental and social changes result from, and shape, governance patterns. The three wetlands studied share commonalities in their trajectories: high population pressure, the enclosure of the commons and subsequent capitalization of resources and social marginalization, conflicting interests and intense local politics, a disconnect between global conservation discourses and local concerns, weak institutional arrangements, and global economic forces. The intense politics of access, control and use of natural resources challenge the implementation of a true polycentric regime in the Indian context due to a tendency to bureaucratization and a lack of participation, and existing limits to democratic citizenship. Creating a democratic space where multiple voices can be considered in the decision-making process remains a challenge. The paper concludes that inclusion of power and politics in the study of governance of natural resources should be of prime concern for researchers and decision makers

Sustainability Challenges for Sub-Saharan Africa: Vulnerability, Justice and Human Capabilities

The global discourse on a desirable path to development has long moved from an emphasis on economic growth towards a conception of development as the ful"lment of human capabilities and freedoms. The concept of human development#– considering levels of education and nutrition, among other factors#– has been widely adopted by the United Nations and international institutions, beyond a conventional notion that mostly associated development with the gross domestic product of countries.info:eu-repo/semantics/publishedVersio